Provider Demographics
NPI:1164648622
Name:KELLEHER, WENDY THERESE (MA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:THERESE
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JULIA WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2127
Mailing Address - Country:US
Mailing Address - Phone:413-536-7677
Mailing Address - Fax:
Practice Address - Street 1:1 JULIA WAY
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2127
Practice Address - Country:US
Practice Address - Phone:413-536-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor