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General NPI Number Information
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NPI Number | 1629407523
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Entity Type | Individual
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Provider Name | ANDREA T WILSON MSW/LSW
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Gender | Female
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 1318 S MAIN RD SUITE 3
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City | VINELAND
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State | NJ
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Zip | 08360-6516
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Country | US
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Telephone | 856-692-1600
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Fax | 856-692-1615
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Provider Business Mailing Address
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Address Line | 1318 SOUTH MAIN RD. #3 THE KIDNEY CENTER AT VINELAND
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City | VINELAND
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State | NJ
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Zip | 08360
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Country | US
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Telephone | 856-692-1600
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Fax | 856-692-1615
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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 | 44SL05265200
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License Number State | NJ
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