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General NPI Number Information
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NPI Number | 1073636874
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Entity Type | Individual
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Provider Name | MARION LYNN WACHTENHEIM M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2007
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | 172 E CUSHING ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-2255
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Country | US
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Telephone | 401-273-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 38 PARIS ST
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City | PAWTUCKET
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State | RI
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Zip | 02860-6129
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Country | US
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Telephone | 401-475-0785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW00678
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License Number State | RI
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