Provider Demographics
NPI:1760982086
Name:WINDERBAUM, MEGAN E (LICSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:WINDERBAUM
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 1:51 UNION ST STE G02
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1138
Mailing Address - Country:US
Mailing Address - Phone:508-556-0745
Mailing Address - Fax:508-519-6539
Practice Address - Street 1:51 UNION ST STE G02
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1138
Practice Address - Country:US
Practice Address - Phone:508-556-0745
Practice Address - Fax:508-519-6539
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2216751041C0700X
MA1041C0700X
MA1212131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical