Provider Demographics
NPI:1952341133
Name:WILSON, SHARON R (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:R
Last Name:WILSON
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 1:485 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-4344
Mailing Address - Country:US
Mailing Address - Phone:412-922-1566
Mailing Address - Fax:412-922-3516
Practice Address - Street 1:485 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4344
Practice Address - Country:US
Practice Address - Phone:412-922-1566
Practice Address - Fax:412-922-3516
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005922L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA652432Medicare UPIN
PA652432RH8Medicare ID - Type Unspecified