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RAVEN WILSON
NPI 1740725050
Counselor - Mental Health in Plattsburgh, NY

Active since December 21, 2016PECOS EnrolledAccepts Medicare Assignment
80 SHARRON AVE, PLATTSBURGH, NY 12901(518) 561-1447(518) 562-8812 Get Directions Write a Review

NPPES record last updated: January 12, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jan 12, 2021, Oct 21, 2020, Dec 27, 2016 and 1 more (4 updates tracked since 2016).

About Raven Wilson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RAVEN WILSON (NPI 1740725050) is an individual mental health provider in Plattsburgh, New York, licensed in New York (010789) and active in the NPI registry since December 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1740725050
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameRAVEN WILSON
Location Address80 SHARRON AVEPlattsburgh, NY 12901-4700
Mailing Address79 Glenridge RdGlenville, NY 12302-4523 · (518) 952-8408 · Fax (518) 952-8287
Phone(518) 561-1447
Fax(518) 562-8812
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateDecember 21, 2016
Last NPPES UpdateJanuary 12, 20214 updates tracked since enumeration
NPPES CertifiedJanuary 12, 2021
✔ NPI 1740725050 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in NY · 010789
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 33417 (NY)
80 SHARRON AVE, Plattsburgh, NY 12901
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Other Identifiers 1

Medicaid01420800NY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Raven Wilson is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9436502507
PECOS Enrollment IDI20240125002047
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Raven Wilson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Conifer Park, Inc.
Same address
Rehabilitation, Substance Use Disorder
80 SHARRON AVE
Plattsburgh, NY 12901
  • Reassigned Medicare billing, New York enrollment
  • 15 clinicians in this Medicare group
NPI 1346296720 (518) 561-1447

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATRINA LOPEZ
Peer Specialist
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 561-1447
COLLEEN COSTIN
Counselor (Addiction (Substance Use Disorder))
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 561-1447
JARED CROY CIT
Counselor (Addiction (Substance Use Disorder))
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 561-1447
CORY RYAN
Peer Specialist
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 561-1447
PATRICK MCCORMICK CASC-T
Counselor (Addiction (Substance Use Disorder))
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 561-1447
STEPHEN GALIETTA CASAC
Counselor (Addiction (Substance Use Disorder))
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 952-8140
JAMES FACTEAU
Counselor (Addiction (Substance Use Disorder))
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 561-1447
LISA SEARS-BOWLEN
Counselor (Addiction (Substance Use Disorder))
80 SHARRON AVE
PLATTSBURGH, NY 12901
Clinton County (518) 561-1447

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Raven Wilson's NPI number?

The NPI number for Raven Wilson is 1740725050. It was assigned to this individual provider in the NPPES registry on December 21, 2016.

Where is Raven Wilson located?

Raven Wilson practices at 80 Sharron Ave, Plattsburgh, NY 12901. The listed phone number is (518) 561-1447.

What is Raven Wilson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Raven Wilson enrolled in Medicare?

Yes. Raven Wilson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Raven Wilson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Raven Wilson reassigns Medicare benefits to Conifer Park, Inc. (Plattsburgh, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Raven Wilson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Raven Wilson was last updated on January 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.