Healthcare Provider Details

I. General information

NPI: 1255401188
Provider Name (Legal Business Name): WENDY MCDONALD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA BOSTON HEALTHCARE SYSTEM 940 BELMONT STREET
BROCKTON MA
02301
US

IV. Provider business mailing address

18 BRADLEY DR UNIT D
GROTON MA
01450-4302
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-3694
  • Fax:
Mailing address:
  • Phone: 978-339-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112101
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: