Provider Demographics
NPI:1427135003
Name:WILBUR, DENNIS YALE (PHD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:YALE
Last Name:WILBUR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4824
Mailing Address - Country:US
Mailing Address - Phone:718-258-1046
Mailing Address - Fax:718-758-7640
Practice Address - Street 1:2014 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4824
Practice Address - Country:US
Practice Address - Phone:718-258-1046
Practice Address - Fax:718-854-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical