Provider Demographics
NPI:1891827143
Name:TWOMBLY, JOANNE HEIDI (MSW)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:HEIDI
Last Name:TWOMBLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MAIN ST
Mailing Address - Street 2:ROOM 105
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0607
Mailing Address - Country:US
Mailing Address - Phone:781-894-1008
Mailing Address - Fax:
Practice Address - Street 1:740 MAIN ST
Practice Address - Street 2:ROOM 105
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0607
Practice Address - Country:US
Practice Address - Phone:781-894-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA019833OtherMBHP
MAP04638OtherBLUE CROSS AND BLUE SHIEL
MD1853813OtherMASSHEALTH
MAP04638Medicare ID - Type Unspecified