Provider Demographics
NPI:1376841189
Name:WILSON, DAVID F (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:F
Last Name:WILSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CLINTON ST APT 505
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3359
Mailing Address - Country:US
Mailing Address - Phone:718-619-7849
Mailing Address - Fax:
Practice Address - Street 1:STATEN ISLAND HOME VISITS
Practice Address - Street 2:55 WADSWORTH ROAD
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306
Practice Address - Country:US
Practice Address - Phone:718-619-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086947-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY086947-1OtherLICENSE NUMBER LCSW