| Organization Name: | WILSON PSYCHOLOGICAL ASSOCIATES LLC |
| NPI Number: | 1083959597 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VICTORIA A WILSON (OWNER) |
| Mailing Address: | 416 Pompton Ave Cedar Grove |
| State: | NJ US |
| Postal Code: | 070091813 |
| Phone Number: | 9732392345 |
| Fax Number: | 9735599162 |
| NPI Enumeration Date: | 12/10/2012 |
| NPI Last Update Date: | 12/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 35S100492700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |