Healthcare Provider Details

I. General information

NPI: 1609981109
Provider Name (Legal Business Name): JANIS SUSAN MONAT L.I.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANIS SUSAN BRAININ L.I.C.S.W

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MYSTIC AVE
MEDFORD MA
02155-4632
US

IV. Provider business mailing address

21 JEFFERSON AVE
SHARON MA
02067-1539
US

V. Phone/Fax

Practice location:
  • Phone: 781-396-1199
  • Fax: 781-396-1439
Mailing address:
  • Phone: 781-784-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number107175
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: