Gordon Bruce Wilson, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CWO13852 Issued in PA

Practice address

562 Wyoming Ave
Kingston, PA 18704-3721

Phone

(570) 552-3760

Fax

(570) 552-3765

NPI assigned

Mar 6, 2009

Last updated

Mar 6, 2009By 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 PA

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

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.

• Children's Service Center of Wyoming Valley, Inc

  • Counselor
  • Wilkes Barre, PA
  • NPI 1700861242
  Medicare reassignment NPD
• Children's Service Center of Wyoming Valley, Inc

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
  • NPI 1710617857
  NPD

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236297600000",
    "number": "1477793271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043721",
            "telephone_number": "570-552-3760",
            "fax_number": "570-552-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043721",
            "telephone_number": "570-552-3760",
            "fax_number": "570-552-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GORDON",
        "middle_name": "BRUCE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "CWO13852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William D Hottenstein MD PC
• William J Scott Jr Ms
• Judy A Williams
• Stephanie S Williams, LCSW
• Williamsport Physical Medicine, Inc. (Neuropathy Center of NEPA)
• Levi Yitzchok Wolff, LPC
• Women to Women
• Allen Woods, D.M.D.
• Wyoming Valley Alcohol and Drug Services Inc
• Wyoming Valley Alcohol and Drug Services Inc (New Bridge Counseling)

• Mental Health Counselor in Kingston, PA
• Providers in Kingston, PA by specialty
• Mental Health Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.