Healthcare Provider Details

I. General information

NPI: 1932592169
Provider Name (Legal Business Name): WENDY J BARBOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 INTERSTATE DR STE 3
WEST SPRINGFIELD MA
01089-5100
US

IV. Provider business mailing address

59 INTERSTATE DR STE 3
WEST SPRINGFIELD MA
01089-5100
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax:
Mailing address:
  • Phone: 774-214-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8468
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW115784
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: