Provider Demographics
NPI:1306866710
Name:O'HARA, WENDY P (LICSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:P
Last Name:O'HARA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:P
Other - Last Name:O'HARA-COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:254 ESSEX STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3411
Mailing Address - Country:US
Mailing Address - Phone:978-594-4787
Mailing Address - Fax:978-594-4787
Practice Address - Street 1:254 ESSEX STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3411
Practice Address - Country:US
Practice Address - Phone:978-594-4787
Practice Address - Fax:978-594-4787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10174711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07726OtherBLUE CROSS BLUE SHIELD
MAP23754Medicare UPIN