Healthcare Provider Details

I. General information

NPI: 1104241215
Provider Name (Legal Business Name): CHERI LYNN WENZEL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 LENOX ST
NORWOOD MA
02062-3416
US

IV. Provider business mailing address

190 LENOX ST
NORWOOD MA
02062-3416
US

V. Phone/Fax

Practice location:
  • Phone: 781-769-8670
  • Fax:
Mailing address:
  • Phone: 781-769-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1027745
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: