Provider Demographics
NPI:1407738768
Name:WILSON, JACQUELINE (MH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 E 14TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1155
Mailing Address - Country:US
Mailing Address - Phone:646-265-8074
Mailing Address - Fax:
Practice Address - Street 1:1664 E 14TH ST FL 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1155
Practice Address - Country:US
Practice Address - Phone:646-265-8074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator