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General NPI Number Information
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NPI Number | 1134354038
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Entity Type | Individual
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Provider Name | JUDITH ROSE-WILSON PHD, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 4130 HUNT PL NE
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City | WASHINGTON
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State | DC
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Zip | 20019-3565
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Country | US
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Telephone | 202-388-4300
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Fax | 202-388-4339
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Provider Business Mailing Address
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Address Line | 3209 APPLE GREEN LN
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City | BOWIE
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State | MD
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Zip | 20716-3877
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Country | US
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Telephone | 301-605-3509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11820
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079492
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License Number State | DC
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