Provider Demographics
NPI:1114425675
Name:WENTZELL, JUDITH DIO (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:DIO
Last Name:WENTZELL
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 1:78 S QUINSIGAMOND AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4268
Mailing Address - Country:US
Mailing Address - Phone:774-442-3879
Mailing Address - Fax:774-441-9705
Practice Address - Street 1:UMASSMEMORIAL MEDICAL CENTER, 55 LAKE AVE NORTH
Practice Address - Street 2:DEPT OF CARE COORDINATION
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:774-442-3879
Practice Address - Fax:774-441-9705
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10157221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical