Provider Demographics
NPI:1184116030
Name:GLADU LANDRY, WENDY A (LICSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:GLADU LANDRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:A
Other - Last Name:GLADU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-0133
Mailing Address - Country:US
Mailing Address - Phone:617-650-3090
Mailing Address - Fax:
Practice Address - Street 1:11 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-2427
Practice Address - Country:US
Practice Address - Phone:617-650-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20181041C0700X
FLTPSW36621041C0700X
MELC229361041C0700X
MA1130541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical