Provider Demographics
NPI:1932322526
Name:SEVERANCE CORDEIRO, WENDY (LICSW, LADCI)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SEVERANCE CORDEIRO
Suffix:
Gender:F
Credentials:LICSW, LADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARTWELL ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3019
Mailing Address - Country:US
Mailing Address - Phone:508-272-4129
Mailing Address - Fax:
Practice Address - Street 1:4 HARTWELL ST STE 305
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3019
Practice Address - Country:US
Practice Address - Phone:508-272-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1837101YA0400X
MA10266031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)