Provider Demographics
NPI:1417047556
Name:CASE, WENDY BOSWORTH (MSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:BOSWORTH
Last Name:CASE
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 1:648 WASHINGTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3576
Mailing Address - Country:US
Mailing Address - Phone:781-769-7849
Mailing Address - Fax:617-332-0392
Practice Address - Street 1:648 WASHINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3576
Practice Address - Country:US
Practice Address - Phone:781-769-7849
Practice Address - Fax:617-332-0392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW 103696-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03598Medicare ID - Type Unspecified