Provider Demographics
NPI:1316023245
Name:WAMBA, ANNE MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:ANNE MARIE
Middle Name:
Last Name:WAMBA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:ANNE MARIE
Other - Middle Name:
Other - Last Name:WAVEZWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:203 LEWIS ST
Mailing Address - Street 2:APT#1
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-4863
Mailing Address - Country:US
Mailing Address - Phone:781-599-4287
Mailing Address - Fax:
Practice Address - Street 1:55 DIMOCK ST
Practice Address - Street 2:COMMUNITY CARE CENTER
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1029
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:617-442-1702
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA931106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist