Provider Demographics
NPI:1780734137
Name:WANJIKU, IRENE E (MA, CAGS, CRC)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:E
Last Name:WANJIKU
Suffix:
Gender:F
Credentials:MA, CAGS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GIBBS ST UNIT C39
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1462
Mailing Address - Country:US
Mailing Address - Phone:508-755-4621
Mailing Address - Fax:
Practice Address - Street 1:11 GIBBS ST UNIT C39
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1462
Practice Address - Country:US
Practice Address - Phone:508-755-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS10236274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional