Provider Demographics
NPI:1821390196
Name:MUGANGA, JOELLE R (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:R
Last Name:MUGANGA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:R
Other - Last Name:VALLIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC SW
Mailing Address - Street 1:480 WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2347
Mailing Address - Country:US
Mailing Address - Phone:781-424-0910
Mailing Address - Fax:
Practice Address - Street 1:480 WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2347
Practice Address - Country:US
Practice Address - Phone:781-424-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1160721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical