Provider Demographics
NPI:1730397365
Name:WILSON, CECILE DANETTE (LCSW)
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:DANETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:C
Other - Middle Name:DANETTE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8333 AUSTIN ST
Mailing Address - Street 2:#3-O
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1800
Mailing Address - Country:US
Mailing Address - Phone:718-849-2418
Mailing Address - Fax:
Practice Address - Street 1:2089 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2117
Practice Address - Country:US
Practice Address - Phone:212-828-6174
Practice Address - Fax:212-828-6145
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056650-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical