MEDICARE: DULCINEA S WETHERELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW128395	MA

General Provider Information

NPI Number	:	1235853888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DULCINEA S WETHERELL

Provider Business Mailing Address
First Line	:	17 BRADBURY AVE # 2
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-4911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	362 MIDDLESEX AVE
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2127
Country	:	US
Telephone Number	:	978-737-7937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	11/05/2024

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Directions to “ DULCINEA S WETHERELL ” Practice Location

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