Provider Demographics
NPI:1184383770
Name:WILAMOWSKI, DORIS (LCSW)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:WILAMOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 QUEENS BLVD APT 22A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3613
Mailing Address - Country:US
Mailing Address - Phone:212-730-0303
Mailing Address - Fax:
Practice Address - Street 1:10420 QUEENS BLVD APT 22A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3613
Practice Address - Country:US
Practice Address - Phone:212-730-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-11
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR16094103TP2701X
NY0160941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5317OtherINSURANCE PRIVATE