Provider Demographics
NPI:1144327065
Name:NELSON, WILBUR JOSEPH JR (PHD)
Entity type:Individual
Prefix:DR
First Name:WILBUR
Middle Name:JOSEPH
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6640
Mailing Address - Country:US
Mailing Address - Phone:860-243-3477
Mailing Address - Fax:860-243-3224
Practice Address - Street 1:3 NORTHWESTERN DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3465
Practice Address - Country:US
Practice Address - Phone:860-243-3477
Practice Address - Fax:860-243-3224
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000818103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist