Healthcare Provider Details

I. General information

NPI: 1902984396
Provider Name (Legal Business Name): CHARLENE ZIENOWICZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PAWTUCKET AVE
RUMFORD RI
02916-1427
US

IV. Provider business mailing address

1240 PAWTUCKET AVE
RUMFORD RI
02916-1427
US

V. Phone/Fax

Practice location:
  • Phone: 401-369-7618
  • Fax: 401-369-7619
Mailing address:
  • Phone: 401-369-7618
  • Fax: 401-369-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01195
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: