Individual
GILA WISEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
3619 QUENTIN RD, BROOKLYN, NY 11234-4203
(718) 998-7500
(718) 998-7955
Mailing address
PO BOX 31094, HARTFORD, CT 06150-1094
(518) 952-8140
(518) 952-8287
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18895
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420795
—
NY
Enumeration date
07/17/2008
Last updated
07/30/2008
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