Provider Demographics
NPI:1770500381
Name:HASKELL, WENDY AYLESWORTH (MSW PHD LICSW)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:AYLESWORTH
Last Name:HASKELL
Suffix:
Gender:F
Credentials:MSW PHD LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45A CHARLESBANK ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458
Mailing Address - Country:US
Mailing Address - Phone:617-965-0652
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON STREET
Practice Address - Street 2:SUITE 7D
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-527-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHAP01198OtherBLUE CROSS BLUE SHIELD
MA710855OtherTUFTS HEALTH CARE
MA7657317OtherPACIFIC CARE & BEHAVORIAL
MAHAP01198Medicaid
MA1857932OtherMASS HEALTH
MAHAP01198Medicaid