Healthcare Provider Details

I. General information

NPI: 1992862833
Provider Name (Legal Business Name): LENORE ANN RUST LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SUNSET LN
PAXTON MA
01612
US

IV. Provider business mailing address

50 SUNSET LN
PAXTON MA
01612-1198
US

V. Phone/Fax

Practice location:
  • Phone: 508-849-3293
  • Fax:
Mailing address:
  • Phone: 508-849-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number231767
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115753
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: