Provider Demographics
NPI:1750482907
Name:WILKES, ALLEN A JR (PHD, CASAC)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:A
Last Name:WILKES
Suffix:JR
Gender:M
Credentials:PHD, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-0450
Mailing Address - Country:US
Mailing Address - Phone:212-982-8807
Mailing Address - Fax:212-982-8807
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PENTHOUSE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-947-7111
Practice Address - Fax:212-982-8807
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12638101YA0400X
NY014078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV4R421Medicare PIN