Ray Sean Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11832 Issued in CT

Practice address

20 Woodside Ave
Middlebury, CT 06762-2857

Phone

(203) 675-5371

NPI assigned

Nov 9, 2021

Last updated

Nov 9, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eclipse Depression Corp.

  • Clinical Social Worker
  • Middlebury, CT
  • NPI 1770225476
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1245996719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 LAVERY LN",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060371272",
            "telephone_number": "203-675-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WOODSIDE AVE",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067622857",
            "telephone_number": "203-675-5371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RAY",
        "middle_name": "SEAN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-09",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "11832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jannese Lauren Webber, LCSW, LADC
• Xiao Jun Weng, MD
• Robert William White, CO
• Wilfred Brown, MD PC
• Kimberly Wilson
• Deanna L Wolff, PA-C
• Milagros Arel Wong
• Gregory D Wright, PT
• Gregory David Wright Jr., OT
• Emma Yungk, OTR/L

• Clinical Social Worker in Middlebury, CT
• Providers in Middlebury, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.