Provider Demographics
NPI:1649728809
Name:WILES, SUSANNA MARIA (LGSW)
Entity type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:MARIA
Last Name:WILES
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:MS
Other - First Name:SUSANNA
Other - Middle Name:MARIA
Other - Last Name:JABINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:7474 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 730
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3504
Mailing Address - Country:US
Mailing Address - Phone:301-345-1022
Mailing Address - Fax:301-560-5558
Practice Address - Street 1:7474 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 730
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3504
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:301-560-5558
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker