Provider Demographics
NPI:1396882817
Name:REICH, WENDY SUE (LICSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:REICH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RUNNING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4754
Mailing Address - Country:US
Mailing Address - Phone:617-327-5770
Mailing Address - Fax:800-293-5581
Practice Address - Street 1:111 RUNNING BROOK RD
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4754
Practice Address - Country:US
Practice Address - Phone:617-327-5770
Practice Address - Fax:800-293-5581
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW 1016194-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1811651OtherMBHP PROVIDER NUMBER
MA765531OtherTUFTS PROVIDER NUMBER
MA190878OtherCOMP PSYCH ROVIDER NUMBER
MA550010004866OtherPACIFICARE PROVIDER NUMBE
MA1851659Medicaid
MAPR-3234726-0001OtherCIGNA PROVIDER NUMBER
MA70010000-P04736OtherBLUE CROSS BLUE SHIELD NO
MASW1016194-1OtherSOCIAL WORK LICENSE NUMBE
MA152865OtherMAGELLAN PROVIDER NO.
MAPR-3234726-0001OtherCIGNA PROVIDER NUMBER