Basic Information
| Provider Information | |||||||||
| NPI: | 1629106661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | ALESSONDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1609 MILL POND DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060744318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604329678 | ||||||||
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| Practice Location | |||||||||
| Address1: | 896 ASYLUM AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605228241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.