Provider Demographics
NPI:1285076182
Name:LARA, WENDY S (MED, LMHC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:LARA
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 NEWHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2510
Mailing Address - Country:US
Mailing Address - Phone:413-231-2181
Mailing Address - Fax:413-781-5729
Practice Address - Street 1:130 MAPLE STREET SUITE 205
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2202
Practice Address - Country:US
Practice Address - Phone:413-739-0882
Practice Address - Fax:413-781-5729
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health