MEDICARE: TAYLOR WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1427819143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR WILSON

Provider Business Mailing Address
First Line	:	30 STONEYCREST DR APT 14
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-6422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 PARK ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5498
Country	:	US
Telephone Number	:	203-848-3061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2024
Last Update Date	:	01/19/2024

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Directions to “ TAYLOR WILSON ” Practice Location

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