Provider Demographics
NPI:1801926779
Name:WILLISON, JUDITH (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:WILLISON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BRAINTREE HILL PARK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-843-8887
Mailing Address - Fax:781-843-3179
Practice Address - Street 1:1419 HANCOCK ST
Practice Address - Street 2:SUITE 302
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5250
Practice Address - Country:US
Practice Address - Phone:781-843-8887
Practice Address - Fax:781-843-3179
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1134891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical