Provider Demographics
NPI:1750183141
Name:WILSON, ADALILA K (CMHC-LP)
Entity type:Individual
Prefix:
First Name:ADALILA
Middle Name:K
Last Name:WILSON
Suffix:
Gender:
Credentials:CMHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NEWBURGH ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4922
Mailing Address - Country:US
Mailing Address - Phone:646-261-0260
Mailing Address - Fax:646-261-0260
Practice Address - Street 1:173 HUGUENOT ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7710
Practice Address - Country:US
Practice Address - Phone:914-246-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP132362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health