Provider Demographics
NPI:1902984396
Name:ZIENOWICZ, CHARLENE (LICSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:ZIENOWICZ
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 1:1240 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1427
Mailing Address - Country:US
Mailing Address - Phone:401-369-7618
Mailing Address - Fax:401-369-7619
Practice Address - Street 1:1240 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1427
Practice Address - Country:US
Practice Address - Phone:401-369-7618
Practice Address - Fax:401-369-7619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW011951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29559-8OtherBLUE CROSS BLUE SHIELD
RI1040910OtherNEIGHBORHOOD HEALTH PLAN
RI412608OtherBLUE CROSS BLUE CHIP