Provider Demographics
NPI:1295048304
Name:WILKERSON, SHARON DENISE
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DENISE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWR
Mailing Address - Street 1:HEALTH SCIENCE CENTER T-10
Mailing Address - Street 2:STONYBROOK UNIVERSITY HOSPITAL DEPARTMENT OF PSYCHIATRY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-8101
Mailing Address - Country:US
Mailing Address - Phone:631-444-2884
Mailing Address - Fax:
Practice Address - Street 1:HEALTH SCIENCE CENTER T-10
Practice Address - Street 2:STONYBROOK UNIVERSITY HOSPITAL DEPARTMENT OF PSYCHIATRY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-8101
Practice Address - Country:US
Practice Address - Phone:631-444-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0516821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical