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General NPI Number Information
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NPI Number | 1992529762
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Entity Type | Organization
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Legal Business Name | MARY ANN WILSON LCSW PLLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2130 FIVE MILE LINE RD
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City | PENFIELD
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State | NY
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Zip | 14526-2292
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Country | US
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Telephone | 585-270-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 505 RIDGEMONT DR
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City | ROCHESTER
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State | NY
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Zip | 14626-3444
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW PLLC
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Name | MRS. MARY ANN WILSON
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Credential |
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Telephone | 585-690-0890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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