Provider Demographics
NPI:1326089343
Name:WILSON, JANET E (LCSWC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:STE 403
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:STE 403
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-823-6408
Practice Address - Fax:443-279-0537
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD051181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
790298000OtherMAGE GROUP #
PVPB117105OtherAPS GROUP #
0020OtherBSDC
226291OtherKAIS
K452OtherBSDC GROUP #
226756000OtherMAGE
002125OtherVAL
226291OtherKAIS GROUP #
705BPSOtherBSMD GROUP #
9397886OtherPHCS
150NOtherMBMD GROUP #
391117OtherMAMS
52092404OtherBSMD
PVPB117105OtherAPS
150N130GOtherMBMD
252450OtherCOMP GROUP #
253561OtherCOMP
331833OtherMHN
593795443OtherMAMS GROUP #
K452OtherBSDC GROUP #