Healthcare Provider Details

I. General information

NPI: 1225959877
Provider Name (Legal Business Name): RACHEL TE'ONA WILSON LCAT-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 MONROE AVE
ROCHESTER NY
14618-3032
US

IV. Provider business mailing address

2376 MONROE AVE
ROCHESTER NY
14618-3032
US

V. Phone/Fax

Practice location:
  • Phone: 585-430-9877
  • Fax:
Mailing address:
  • Phone: 585-430-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberP143892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: