Individual
ANGELA R WENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
403 BELMONT ST, WORCESTER, MA 01604-1019
(413) 584-4040
Mailing address
403 BELMONT ST, WORCESTER, MA 01604-1019
(413) 584-4040
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
10177
MA
103TC0700X
Clinical Psychologist
Primary
10177
MA
103TC2200X
Clinical Child & Adolescent Psychologist
10177
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110105680A
—
MA
01
—
S400258076
MEDICARE
MA
Enumeration date
06/25/2015
Last updated
02/27/2024
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