Provider Demographics
NPI:1982751590
Name:LOBEL, WENDY LYNN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LYNN
Last Name:LOBEL
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 1:209 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2926
Mailing Address - Country:US
Mailing Address - Phone:508-584-2291
Mailing Address - Fax:508-584-3480
Practice Address - Street 1:209 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2926
Practice Address - Country:US
Practice Address - Phone:508-584-2291
Practice Address - Fax:508-584-3480
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1059911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical