| Doctor Name: | DR. DAVID S. WILSON |
| NPI Number: | 1003984139 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | R035519-1 |
| Business Practice Address: | 21804 40th Ave Bayside, NY - 113612356 |
| Business Phone Number: | 7182246660 |
| Business Fax Number: | 7186315971 |
| Mailing Address: | 21804 40th Ave, BAYSIDE |
| State: | NY |
| Postal Code: | 113612356 |
| Phone Number: | 7182246660 |
| Fax Number: | 7186315971 |
| NPI Enumeration Date: | 11/30/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R035519-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |