MEDICARE: PATRICIA MARIE WILKINSON LCSW

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
1	1041C0700X	Clinical Social Worker	0904002879	VA

General Provider Information

NPI Number	:	1316097884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIE WILKINSON LCSW

Provider Business Mailing Address
First Line	:	481 MCLAWS CIR
Second Line	:	SUITE 1
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-5645
Country	:	US
Telephone Number	:	757-879-5525
Fax Number	:	757-229-9626

Provider Business Practice Location Address
First Line	:	481 MCLAWS CIR
Second Line	:	SUITE 1
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-5645
Country	:	US
Telephone Number	:	757-879-5525
Fax Number	:	757-229-9626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	05/14/2009

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