Provider Demographics
NPI:1013536671
Name:RAINBOTH, KIT LUSSIER (LICSW)
Entity Type:Individual
Prefix:
First Name:KIT
Middle Name:LUSSIER
Last Name:RAINBOTH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 WEBSTER ST UNIT G
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2975
Mailing Address - Country:US
Mailing Address - Phone:857-218-9617
Mailing Address - Fax:
Practice Address - Street 1:96 WEBSTER ST UNIT G
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2975
Practice Address - Country:US
Practice Address - Phone:857-218-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1255911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical