Provider Demographics
NPI:1679317739
Name:WILSON REID, CLAUDINE
Entity type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:
Last Name:WILSON REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 VILLAGE RD APT D
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4434
Mailing Address - Country:US
Mailing Address - Phone:908-377-1702
Mailing Address - Fax:
Practice Address - Street 1:418 -424 CENTRAL AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090
Practice Address - Country:US
Practice Address - Phone:888-261-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty