Active NPI
Jeanine Michelle Wilson, LICSW
- Clinical Social Worker
- Upper Marlboro, MD
National Provider Identifier
1033418611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC50078965
- Practice address
- 4809 Colonel Brooke CT
Upper Marlboro, MD 20772-2872 - Phone
- (410) 507-8183
- Fax
- (301) 780-3271
- NPI assigned
- Mar 22, 2011
- Last updated
- Mar 22, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC50078965 | DC | Primary |
Addresses
Primary practice location
4809 Colonel Brooke CT
Upper Marlboro, MD 20772-2872
Mailing address
4809 Colonel Brooke CT
Upper Marlboro, MD 20772-2872
Phone (410) 507-8183
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC50078965 | DC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300752000000",
"number": "1033418611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4809 COLONEL BROOKE CT",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207722872",
"telephone_number": "410-507-8183",
"fax_number": "301-780-3271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4809 COLONEL BROOKE CT",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207722872",
"telephone_number": "410-507-8183",
"fax_number": "301-780-3271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JEANINE",
"middle_name": "MICHELLE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-22",
"last_updated": "2011-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC50078965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.