Healthcare Provider Details

I. General information

NPI: 1467668400
Provider Name (Legal Business Name): SETH PALMER WILSON LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE SW BLDG 1300
BOLLING AFB DC
20032-7704
US

IV. Provider business mailing address

238 BROOKLEY AVE SW BLDG 1300
BOLLING AFB DC
20032-7704
US

V. Phone/Fax

Practice location:
  • Phone: 202-767-0611
  • Fax:
Mailing address:
  • Phone: 802-236-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089.0074431
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: