Individual
MR. JONATHAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
327 MAIN ST, LAKEVILLE, CT 06039-1205
(860) 435-2210
Mailing address
PO BOX 661, LAKEVILLE, CT 06039-0661
(860) 491-5605
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005223
CT
Other
Enumeration date
01/04/2022
Last updated
01/04/2022
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