Provider Demographics
NPI:1699987016
Name:LEWIS, WENDY (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2714
Mailing Address - Country:US
Mailing Address - Phone:781-235-7999
Mailing Address - Fax:781-235-7999
Practice Address - Street 1:105 CHESTNUT ST
Practice Address - Street 2:SUITE 31
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2599
Practice Address - Country:US
Practice Address - Phone:781-235-7999
Practice Address - Fax:781-235-7999
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1076981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S85051Medicare UPIN
MALEP21316Medicare ID - Type Unspecified