Provider Demographics
NPI:1649257346
Name:WILSON, LAMONTE GARNETT (MSW)
Entity type:Individual
Prefix:
First Name:LAMONTE
Middle Name:GARNETT
Last Name:WILSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 AIRDRIE DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2361
Mailing Address - Country:US
Mailing Address - Phone:302-399-5773
Mailing Address - Fax:
Practice Address - Street 1:260 CHAPMAN RD
Practice Address - Street 2:SUITE-200-1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5490
Practice Address - Country:US
Practice Address - Phone:302-399-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQI-00005481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
510-37-5216OtherFEIN