Provider Demographics
NPI:1730676818
Name:LISTERUD, VERONICA MARGARET WATKINS (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MARGARET WATKINS
Last Name:LISTERUD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-1622
Mailing Address - Country:US
Mailing Address - Phone:508-783-4964
Mailing Address - Fax:
Practice Address - Street 1:21 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2530
Practice Address - Country:US
Practice Address - Phone:508-459-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical