Provider Demographics
NPI:1114079803
Name:AMRITANAND- FORT, RUHINA ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:RUHINA
Middle Name:ELIZABETH
Last Name:AMRITANAND- FORT
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 1:175 Q CENTER STREET # 1720
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-770-2145
Mailing Address - Fax:
Practice Address - Street 1:1601 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-425-2040
Practice Address - Fax:617-425-2043
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical