Provider Information for 1053496588
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Mrs. IRIS MARA WILSEK LCSW
Sex: Female
NPI: 1053496588
Last Updated: 2018-07-31
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1053496588 | ||||||||
| Enumeration Date | 2006-10-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1601 SW ARCHER RD GAINESVILLE, FL 32608-1135 United States Phone: 352-575-8432 | Fax: | ||||||||
| Primary Practice Address | 1601 SW ARCHER RD GAINESVILLE, FL 32608 United States Phone: 352-575-8432 | Fax: | ||||||||
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