Provider Demographics
NPI:1780095042
Name:KRENIS, WILDRED RACHEL (MA, LMHC)
Entity type:Individual
Prefix:
First Name:WILDRED
Middle Name:RACHEL
Last Name:KRENIS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 WHITNEY ST
Mailing Address - Street 2:APT 606
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3263
Mailing Address - Country:US
Mailing Address - Phone:774-641-3013
Mailing Address - Fax:
Practice Address - Street 1:241 BOSTON POST RD W
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4614
Practice Address - Country:US
Practice Address - Phone:774-641-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health