Healthcare Provider Details

I. General information

NPI: 1023708328
Provider Name (Legal Business Name): KATHLEEN UWAKWE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 08/10/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BOSTON TPKE STE 314
SHREWSBURY MA
01545-3476
US

IV. Provider business mailing address

415 BOSTON TPKE STE 31401545
SHREWSBURY MA
01545-3446
US

V. Phone/Fax

Practice location:
  • Phone: 978-999-2165
  • Fax:
Mailing address:
  • Phone: 978-999-2165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number226801
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: