| Doctor Name: | REBECCA WILSON |
| NPI Number: | 1003124959 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 007391 |
| Business Practice Address: | 134 State St Meriden, CT - 064503293 |
| Business Phone Number: | 2032372229 |
| Business Fax Number: | 2036861677 |
| Mailing Address: | 635 Main St, Attn: Credentialing Dpt MIDDLETOWN |
| State: | CT |
| Postal Code: | 064572718 |
| Phone Number: | 8603476971 |
| Fax Number: | 8606386601 |
| NPI Enumeration Date: | 09/14/2010 |
| NPI Last Update Date: | 09/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 007391 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |