Provider Demographics
NPI:1891004727
Name:WILKS, GERALD
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:WILKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 W 125TH ST
Mailing Address - Street 2:12 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4436
Mailing Address - Country:US
Mailing Address - Phone:212-961-4399
Mailing Address - Fax:212-866-2760
Practice Address - Street 1:163 W 125TH ST
Practice Address - Street 2:12 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4436
Practice Address - Country:US
Practice Address - Phone:212-961-4399
Practice Address - Fax:212-866-2760
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker