Provider Demographics
NPI:1003292921
Name:MUMFORD, WENDY (LICSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MUMFORD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-1827
Mailing Address - Country:US
Mailing Address - Phone:508-330-1545
Mailing Address - Fax:
Practice Address - Street 1:189 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825
Practice Address - Country:US
Practice Address - Phone:508-330-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW025611041C0700X
MA1189001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical