Provider Demographics
NPI:1801947536
Name:WILSON, ELIZABETH HAYES (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HAYES
Last Name:WILSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WHITCOMB RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4050
Mailing Address - Country:US
Mailing Address - Phone:508-472-3116
Mailing Address - Fax:
Practice Address - Street 1:7 WHITCOMB RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4050
Practice Address - Country:US
Practice Address - Phone:508-472-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8511103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA822716000OtherMAGELLAN PROVIDER NUMBER
MAW06480OtherBCBS PROVIDER NUMBER