Healthcare Provider Details

I. General information

NPI: 1356981005
Provider Name (Legal Business Name): OLGA MARIA WEDDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 COMMERCIAL ST
MASHPEE MA
02649-6507
US

IV. Provider business mailing address

33 COHASSET AVE APT 3
BUZZARDS BAY MA
02532-3270
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-7090
  • Fax:
Mailing address:
  • Phone: 413-822-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127707
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: