Provider Demographics
NPI:1790821296
Name:WHEELER, DONA LEA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONA
Middle Name:LEA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DONA
Other - Middle Name:WHEELER
Other - Last Name:PARDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:55 PUTNEY RD
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9534
Mailing Address - Country:US
Mailing Address - Phone:413-549-0051
Mailing Address - Fax:
Practice Address - Street 1:16 CENTER ST
Practice Address - Street 2:SUITE 223
Practice Address - City:NORTHHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-348-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853627Medicaid
MA1853627Medicaid