Healthcare Provider Details

I. General information

NPI: 1689963407
Provider Name (Legal Business Name): WENDY M SOUSA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 HARMONY HILL RD
CHEPACHET RI
02814-1429
US

IV. Provider business mailing address

77 B CENTRAL PIKE
FOSTER RI
02825
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-0690
  • Fax: 401-949-4412
Mailing address:
  • Phone: 401-647-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01211
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: