Provider Demographics
NPI:1649299116
Name:WING, JOAN WEINFELD (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:WEINFELD
Last Name:WING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-2334
Mailing Address - Country:US
Mailing Address - Phone:978-887-9793
Mailing Address - Fax:
Practice Address - Street 1:56 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-2334
Practice Address - Country:US
Practice Address - Phone:978-887-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21894Medicare ID - Type Unspecified