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NPI Code Detail

MEDICARE: DR. JUDITH ROSE-WILSON PHD, LCSW-C

MEDICARE: DR. JUDITH ROSE-WILSON PHD, LCSW-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker11820MD
21041C0700XClinical Social WorkerLC50079492DC

General Provider Information

NPI Number : 1134354038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUDITH ROSE-WILSON PHD, LCSW-C
Provider Business Mailing Address
First Line : 3209 APPLE GREEN LN
Second Line :
City : BOWIE
State : MD
Zip : 20716-3877
Country : US
Telephone Number : 301-605-3509
Fax Number :
Provider Business Practice Location Address
First Line : 4130 HUNT PL NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-3565
Country : US
Telephone Number : 202-388-4300
Fax Number : 202-388-4339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2009
Last Update Date : 12/06/2023

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