Healthcare Provider Details

I. General information

NPI: 1487795415
Provider Name (Legal Business Name): JUDITH DWELLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TAUNTON GRN STE 5
TAUNTON MA
02780-3243
US

IV. Provider business mailing address

104 NEVENS CIR
ROCKLAND MA
02370-2368
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2023093
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: