Provider Demographics
NPI:1841890043
Name:WILSON, JULIET RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:RENEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-1809
Mailing Address - Country:US
Mailing Address - Phone:443-415-4824
Mailing Address - Fax:410-939-1046
Practice Address - Street 1:1811 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-1809
Practice Address - Country:US
Practice Address - Phone:443-415-4824
Practice Address - Fax:410-939-1046
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00118191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical