Provider Demographics
NPI:1407878432
Name:BAIRU, WUNESH WOLDESELASSIE (LMHC)
Entity Type:Individual
Prefix:
First Name:WUNESH
Middle Name:WOLDESELASSIE
Last Name:BAIRU
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ROFFEE ST
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3030
Mailing Address - Country:US
Mailing Address - Phone:401-289-0113
Mailing Address - Fax:
Practice Address - Street 1:60 BAY SPRING AVE UNIT B1
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1386
Practice Address - Country:US
Practice Address - Phone:401-246-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMHC00533OtherSTATE LICENSE NUMBER
RIWB61550Medicare PIN