Provider Demographics
NPI:1790239523
Name:HARDISON, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HARDISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:HARDISON-MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80 ERDMAN WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1840
Mailing Address - Country:US
Mailing Address - Phone:978-870-1840
Mailing Address - Fax:978-870-1846
Practice Address - Street 1:80 ERDMAN WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:978-870-1840
Practice Address - Fax:978-870-1846
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health