Provider Demographics
NPI:1356422331
Name:GABRENYA, WENDY C (LICSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:C
Last Name:GABRENYA
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 1:76 BEDFORD ST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4646
Mailing Address - Country:US
Mailing Address - Phone:781-861-0081
Mailing Address - Fax:781-862-2276
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 26
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-861-0081
Practice Address - Fax:781-862-2276
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1057121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGA P22095Medicare ID - Type Unspecified