Provider Demographics
NPI:1205811411
Name:DEWHURST, MARIE CHRISTINE (MSW CISW)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:CHRISTINE
Last Name:DEWHURST
Suffix:
Gender:F
Credentials:MSW CISW
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:
Other - Last Name:DEWHURST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:116 HIGH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1887
Mailing Address - Country:US
Mailing Address - Phone:401-596-8505
Mailing Address - Fax:401-423-1188
Practice Address - Street 1:116 HIGH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-1887
Practice Address - Country:US
Practice Address - Phone:401-596-8505
Practice Address - Fax:401-423-1188
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00239104100000X
MA1016605104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI809023599Medicare ID - Type Unspecified