Healthcare Provider Details

I. General information

NPI: 1316597842
Provider Name (Legal Business Name): WADE MUNROE, PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 11/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 MAIN ST
SHREWSBURY MA
01545-2920
US

IV. Provider business mailing address

588 MAIN ST
SHREWSBURY MA
01545-2920
US

V. Phone/Fax

Practice location:
  • Phone: 617-680-5636
  • Fax:
Mailing address:
  • Phone: 617-680-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. WADE MUNROE
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 617-680-5636