Individual
DR. BRUCE LESLIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
153 E MAIN ST, SUITE E, MOUNT KISCO, NY 10549-2317
(914) 666-0060
(914) 666-9662
Mailing address
PO BOX 2526, BRIARCLIFF MANOR, NY 10510-8126
(914) 666-0060
(914) 666-9662
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
0096961
NY
103TC0700X
Clinical Psychologist
Primary
009606
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0078820
GHI
NY
01
—
113511
VALUE OPTIONS
NY
01
—
6152362
UNITED BEHAVIORAL HEALTH
NY
01
—
S096065
WORKERS COMPENSATION
NY
01
—
WS1191
OXFORD HEALTH PLANS
NY
Enumeration date
01/18/2007
Last updated
02/26/2019
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