Individual
MELISSA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27 BARKER AVE APT 311, WHITE PLAINS, NY 10601-1558
(845) 489-2842
Mailing address
27 BARKER AVE APT 311, WHITE PLAINS, NY 10601-1558
(845) 489-2842
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
561133111
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174400000X
EARLY INTERVENTION SERVICE PROVIDER
NY
Enumeration date
09/11/2012
Last updated
09/14/2012
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