Individual
LAURIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 WEST 12TH STREET, 6A, NEW YORK, NY 10011
(212) 620-0695
Mailing address
175 W 12TH ST, 6A, NEW YORK, NY 10011-8275
(212) 620-0695
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
000019
NY
Other
Enumeration date
05/18/2007
Last updated
10/28/2015
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