Provider Demographics
NPI:1912096025
Name:WILE, KARIN ELISABETH (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:ELISABETH
Last Name:WILE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ERLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1125
Mailing Address - Country:US
Mailing Address - Phone:631-751-2090
Mailing Address - Fax:631-689-1922
Practice Address - Street 1:34 ERLAND ROAD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1125
Practice Address - Country:US
Practice Address - Phone:631-751-2090
Practice Address - Fax:631-689-1922
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0201161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0070506OtherGHI
NY090165OtherVALUE OPTIONS
NYP271870OtherOXFORD
179677OtherMHN
0004417970OtherAETNA
0004417970OtherAETNA