MEDICARE: CLAIRE ELIZABETH WILSON MS ED, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	000373	NY
2	103K00000X	Behavior Analyst	000373	NY

General Provider Information

NPI Number	:	1508254434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE ELIZABETH WILSON MS ED, BCBA

Provider Business Mailing Address
First Line	:	25 GRANT ST
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-1101
Country	:	US
Telephone Number	:	631-806-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 GRANT ST
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-1101
Country	:	US
Telephone Number	:	631-806-0615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	07/12/2022

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