Provider Demographics
NPI:1831382316
Name:WILKINS, JANE LESLIE (PHD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LESLIE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 56TH STREET
Mailing Address - Street 2:APT 9H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4318
Mailing Address - Country:US
Mailing Address - Phone:212-977-5479
Mailing Address - Fax:212-799-6805
Practice Address - Street 1:211 W 56TH STREET
Practice Address - Street 2:APT 9H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4319
Practice Address - Country:US
Practice Address - Phone:212-977-5479
Practice Address - Fax:212-799-6805
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0219831104100000X
NJ44SC01469500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN73841JWMedicare PIN