Healthcare Provider Details

I. General information

NPI: 1326954678
Provider Name (Legal Business Name): LATESHA WILKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FEARING ST
AMHERST MA
01002-1941
US

IV. Provider business mailing address

83 TIFFANY DR
WINDSOR CT
06095-2471
US

V. Phone/Fax

Practice location:
  • Phone: 413-206-6261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW.011827
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: