Provider Demographics
NPI:1942705785
Name:DOTTIN-WILSON, ANIKA STEPHANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:STEPHANIE
Last Name:DOTTIN-WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANIKA
Other - Middle Name:STEPHANIE
Other - Last Name:DOTTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 WINDING BROOK DR APT 1D
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9740
Mailing Address - Country:US
Mailing Address - Phone:347-706-0922
Mailing Address - Fax:
Practice Address - Street 1:9 WINDING BROOK DR APT 1D
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9740
Practice Address - Country:US
Practice Address - Phone:347-706-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY094500OtherNYSED OFFICE OF THE PROFESSIONS