Provider Demographics
NPI:1063461309
Name:DEWOLF, JENNIFER MACDONALD (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MACDONALD
Last Name:DEWOLF
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WEETAMOE FARM DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-5199
Mailing Address - Country:US
Mailing Address - Phone:401-245-0533
Mailing Address - Fax:
Practice Address - Street 1:2679 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-2613
Practice Address - Country:US
Practice Address - Phone:401-935-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health