Provider Demographics
NPI:1982835419
Name:WILKINSON, RENEE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MARIE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5324
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90409-5324
Mailing Address - Country:US
Mailing Address - Phone:213-709-0999
Mailing Address - Fax:213-404-7999
Practice Address - Street 1:114 BUCCANEER ST
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5116
Practice Address - Country:US
Practice Address - Phone:213-709-0999
Practice Address - Fax:213-404-7999
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20882103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic