Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Wesley Demarius Willis, PSYD, LCSW-R, RN

Individual provider Clinical Social Worker · NPI 1629299664

Dr. Wesley Demarius Willis, PSYD, LCSW-R, RN is a Clinical Social Worker in New York, New York. Licensed in New York. Registered with an NPI since 2007.

Licensed in
NY
In the registry since
2007
Specialties on file
2
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.
RN — Registered Nurse
A licensed nurse who completed a nursing degree and passed the NCLEX-RN examination.

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Practice location Address checks out

1740 Broadway Fl 15
New York, NY 10019-4605
Phone: (347) 502-0965
Fax: (917) 725-8319
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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 · Licence 076729 (NY)
Registered Nurse Taxonomy 163W00000X · Licence 650621 (NY)

Record details

NPI number1629299664
Entity typeIndividual (Type 1)
GenderMale
Credentials PSYD , LCSW-R , RN
Sole proprietorNo
NPI enumeratedMay 1, 2007
Last updated in NPPESApril 3, 2024
Certification dateApril 3, 2024

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