Provider Demographics
NPI:1720690456
Name:WILSON, MARIT DENHAM (LCSW)
Entity type:Individual
Prefix:
First Name:MARIT
Middle Name:DENHAM
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 1:386 FORE ST STE 401A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-7408
Mailing Address - Country:US
Mailing Address - Phone:802-281-3204
Mailing Address - Fax:
Practice Address - Street 1:386 FORE ST STE 401A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-7408
Practice Address - Country:US
Practice Address - Phone:802-281-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker