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General NPI Number Information
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NPI Number | 1598018038
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Entity Type | Individual
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Provider Name | PAUL R WILSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 33 UNIVERSITY AVENUE
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City | ROCHESTER
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State | NY
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Zip | 14605-2825
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Country | US
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Telephone | 585-535-9115
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Fax | 585-922-2583
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Provider Business Mailing Address
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Address Line | 33 UNIVERSITY AVENUE
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City | ROCHESTER
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State | NY
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Zip | 14605-2825
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Country | US
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Telephone | 585-535-9115
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Fax | 585-419-5468
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 078950
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 084470
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License Number State | NY
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