Provider Demographics
NPI:1902039357
Name:KNIGHT, WENDY B (LICSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:B
Last Name:KNIGHT
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 1:37 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2512
Mailing Address - Country:US
Mailing Address - Phone:508-789-1047
Mailing Address - Fax:
Practice Address - Street 1:23 E ELM AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170
Practice Address - Country:US
Practice Address - Phone:508-555-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1168501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical