Provider Demographics
NPI:1386974715
Name:WILSON, DENISE LYNN (MA, EDM)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VALENTE DR
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-8213
Mailing Address - Country:US
Mailing Address - Phone:518-495-7143
Mailing Address - Fax:
Practice Address - Street 1:50 REMSEN ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2605
Practice Address - Country:US
Practice Address - Phone:518-235-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)