Provider Demographics
NPI:1548538978
Name:WECHSLER, JOHANNA (LMSW)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:WECHSLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 MEMORIAL DR APT 203
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4898
Mailing Address - Country:US
Mailing Address - Phone:323-363-0784
Mailing Address - Fax:
Practice Address - Street 1:328 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1840
Practice Address - Country:US
Practice Address - Phone:323-363-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1208101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical