Provider Demographics
NPI:1811478761
Name:WEDGE, TONI (MA, LSW, LADC-I)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:WEDGE
Suffix:
Gender:F
Credentials:MA, LSW, LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160A PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2706
Mailing Address - Country:US
Mailing Address - Phone:978-494-4508
Mailing Address - Fax:
Practice Address - Street 1:160A PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2706
Practice Address - Country:US
Practice Address - Phone:978-494-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17280101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty