Provider Demographics
NPI:1295751881
Name:SEMONOFF, JUDITH W (LICSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:W
Last Name:SEMONOFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3515
Mailing Address - Country:US
Mailing Address - Phone:401-339-4560
Mailing Address - Fax:
Practice Address - Street 1:1430 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1623
Practice Address - Country:US
Practice Address - Phone:781-647-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1156881041C0700X
RIISW013511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6400144OtherEI UHP
RI292177OtherEI BCROSS
RI412296OtherEI BCHIP
RI2092OtherEI NHPRC
RIES01788Medicaid