Individual
MS. CARMEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
1 TRADEWINDS RD, OAK BLUFFS, OAK BLUFFS, MA 02557-1325
(508) 693-7403
Mailing address
PO BOX 758, WEST TISBURY, MA 02575-0758
(508) 693-7403
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
140745
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCBS
LICSW
MA
Enumeration date
04/02/2007
Last updated
07/08/2007
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