Provider Demographics
NPI:1093859266
Name:SIMPSON, WENDY HARE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:HARE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813-1 CHESAPEAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-9401
Mailing Address - Country:US
Mailing Address - Phone:410-221-2266
Mailing Address - Fax:410-221-2878
Practice Address - Street 1:813-1 CHESAPEAKE DRIVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-9401
Practice Address - Country:US
Practice Address - Phone:410-221-2266
Practice Address - Fax:410-221-2878
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD093451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF793 0004OtherBCBS- FEDERAL
MD106430OtherCIGNA
MD479302100Medicaid
MD7592348OtherAETNA GROUP#
MD010618101OtherFEDERAL TAX ID#
MD388898OtherALLIANCE GROUP#
MD228840-000OtherMAGELLAN MIS#
MD283833OtherALLIANCE INDIVIDUAL#
MD7547424OtherAETNA INDIVIDUAL#
MDPVPB124412OtherCOVENTRY
MD206884OtherCOMPSYCH
MD725228OtherNCPPO
MDKBM9 61596701OtherBCBS- STATE
MD7592348OtherAETNA GROUP#