Provider Demographics
NPI:1376963207
Name:LUNDBERG, JOSHUA (MSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LUNDBERG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-5836
Mailing Address - Country:US
Mailing Address - Phone:860-889-8346
Mailing Address - Fax:
Practice Address - Street 1:28 HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6111
Practice Address - Country:US
Practice Address - Phone:860-443-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker