Provider Demographics
NPI:1063488468
Name:WILSON, DANIEL W (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:W
Last Name:WILSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 MORRISON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1732
Mailing Address - Country:US
Mailing Address - Phone:202-669-5959
Mailing Address - Fax:202-363-2846
Practice Address - Street 1:2000 P ST NW
Practice Address - Street 2:SUITE 412
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5915
Practice Address - Country:US
Practice Address - Phone:202-669-5959
Practice Address - Fax:202-363-2846
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3033111041C0700X
MD107211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCAREFIRST BCBSOtherPPO
DCCAREFIRST BCBSOtherPPO