Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Charrisse Leiana Wilson, LCSW

Individual provider Clinical Social Worker · NPI 1639853013

Charrisse Leiana Wilson, LCSW is a Clinical Social Worker in Bloomsburg, Pennsylvania. Qualified in 2002, 24 years ago. Practices with Supportive Care of Pennsylvania LLC, a 93-clinician group and accepts Medicare assignment.

Years since qualifying
24
In the registry since
2023
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

211 E 1st St
Bloomsburg, PA 17815-1405
Phone: (718) 506-1115
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1639853013
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJune 14, 2023
Last updated in NPPESJune 14, 2023
Certification dateJune 14, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Supportive Care Of Pennsylvania Llc — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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