Provider Demographics
NPI:1063905966
Name:DALTON-WISE, KATILYN (MSW)
Entity type:Individual
Prefix:
First Name:KATILYN
Middle Name:
Last Name:DALTON-WISE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WARD ST # 1
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5025
Mailing Address - Country:US
Mailing Address - Phone:617-470-2488
Mailing Address - Fax:
Practice Address - Street 1:18 WARD ST # 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5025
Practice Address - Country:US
Practice Address - Phone:617-470-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor