Provider Demographics
NPI:1942346044
Name:LUNDBERG, BETH ANNE NMI (MSW)
Entity Type:Individual
Prefix:
First Name:BETH ANNE
Middle Name:NMI
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3324
Mailing Address - Country:US
Mailing Address - Phone:508-475-2600
Mailing Address - Fax:508-475-2604
Practice Address - Street 1:288 LYMAN ST
Practice Address - Street 2:BUTLER CENTER, ALLEN HALL
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2633
Practice Address - Country:US
Practice Address - Phone:508-475-2600
Practice Address - Fax:508-475-2604
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016299-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical