Provider Demographics
NPI:1497234371
Name:WENDEL, LANE (LICSW)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:
Last Name:WENDEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SOLEY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3310
Mailing Address - Country:US
Mailing Address - Phone:978-766-3086
Mailing Address - Fax:
Practice Address - Street 1:41 SOLEY ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3310
Practice Address - Country:US
Practice Address - Phone:617-564-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2219741041C0700X
MA1216251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical