Provider Demographics
NPI:1770930596
Name:WIBERG, HUGO WILLIAM III (LCSW)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:WILLIAM
Last Name:WIBERG
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2518
Mailing Address - Country:US
Mailing Address - Phone:978-664-4447
Mailing Address - Fax:
Practice Address - Street 1:17 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2518
Practice Address - Country:US
Practice Address - Phone:978-664-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA336715104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker