Provider Demographics
NPI:1578184768
Name:WANG, ANNI
Entity Type:Individual
Prefix:MISS
First Name:ANNI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-4016
Mailing Address - Country:US
Mailing Address - Phone:844-642-9355
Mailing Address - Fax:413-732-0309
Practice Address - Street 1:153 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4016
Practice Address - Country:US
Practice Address - Phone:844-642-9355
Practice Address - Fax:413-732-0309
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health