Wilson, Raven

Wilson, Raven is an individual health care provider with primary practice located at 80 Sharron Ave , Plattsburgh NY 12901-4700. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Wilson, Raven can be contacted via phone (518) 561-1447.

Contact Information

Primary practice address
80 Sharron Ave Plattsburgh NY 12901-4700
Phone: (518) 561-1447
Fax: (518) 562-8812
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 010789 New York
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 33417 New York

Profile Details

NPI number 1740725050
LBN Legal business name Wilson, Raven
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 21st, 2016
Last updated Jan 12th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740725050 NPPES
New York MEDICAID 01420800

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