Robert E. Wilson, PSY. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

03174 Issued in MD

Practice address

200 Booth St
Elkton, MD 21921-5657

Phone

(410) 996-5104

Fax

(410) 996-5197

NPI assigned

Jan 11, 2007

Last updated

Jul 13, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Upper Bay Counseling and Support Services, Inc.Group PAC ID 3971405085, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Upper Bay Counseling & Support Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elkton, MD
  • NPI 1316912652
  Medicare reassignment Care Compare group NPD
• Upper Bay Counseling and Support Services, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Havre de Grace, MD
  • NPI 1114252020
  NPD

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1386794519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 SABLEWOOD RD APT K",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143430",
            "telephone_number": "410-638-8075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BOOTH ST",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215657",
            "telephone_number": "410-996-5104",
            "fax_number": "410-996-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "PSY. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "03174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheyla Kemille Williams-Geronimo, M.A. CCC-SLP
• Charleen Williams
• Cheryl Elaine Williams
• Maylene Williams
• Michael Tyler Wilson, ADT
• Wings of Faith LLC
• Kieran Einar Wolff
• Women Medical Care, LLC
• Womens Health Associates,P.C.
• Christopher Wood, O.D.

• Clinical Psychologist in Elkton, MD
• Providers in Elkton, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.