Healthcare Provider Details

I. General information

NPI: 1467318329
Provider Name (Legal Business Name): MISS LYNN DAWN WIDEBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1R NEWBURY ST STE 401
PEABODY MA
01960-3816
US

IV. Provider business mailing address

15 BISHOP WAY
ROWLEY MA
01969-2233
US

V. Phone/Fax

Practice location:
  • Phone: 617-804-2773
  • Fax:
Mailing address:
  • Phone: 978-518-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: