Provider Demographics
NPI:1023785094
Name:WILKES, ADAM (MENTOR)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:WILKES
Suffix:
Gender:M
Credentials:MENTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4609
Mailing Address - Country:US
Mailing Address - Phone:917-485-7600
Mailing Address - Fax:
Practice Address - Street 1:501 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4609
Practice Address - Country:US
Practice Address - Phone:917-485-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker