Provider Demographics
NPI:1982679908
Name:WILBUR-ALBERTSON, JUDY MARIE (MSSS LICSW)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:MARIE
Last Name:WILBUR-ALBERTSON
Suffix:
Gender:F
Credentials:MSSS LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 ODIORNE POINT RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8708
Mailing Address - Country:US
Mailing Address - Phone:603-431-8526
Mailing Address - Fax:603-436-2126
Practice Address - Street 1:539 ISLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-431-8526
Practice Address - Fax:603-436-2126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH56103T00000X, 1041C0700X
MA105493103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80002304Medicaid
ME01807OtherLCSW NUMBER