Provider Demographics
NPI:1255401188
Name:MCDONALD, WENDY (LICSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MCDONALD
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 1:18 BRADLEY DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-4302
Mailing Address - Country:US
Mailing Address - Phone:978-339-9153
Mailing Address - Fax:
Practice Address - Street 1:VA BOSTON HEALTHCARE SYSTEM
Practice Address - Street 2:940 BELMONT STREET
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 1041S0200X
MA1121011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA112101OtherCOMMONWEALTH OF MA, DIVISION OF PROFESSIONAL LICENSURE, BOARD OF SOCIAL WORKERS