Provider Demographics
NPI:1346313699
Name:RUSTOW, JANET SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:SUSAN
Last Name:RUSTOW
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 1:14 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1813
Mailing Address - Country:US
Mailing Address - Phone:617-688-5814
Mailing Address - Fax:617-232-3044
Practice Address - Street 1:1330 BEACON ST
Practice Address - Street 2:STE 349
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3204
Practice Address - Country:US
Practice Address - Phone:617-688-5814
Practice Address - Fax:617-232-3044
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1050691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARU P21160Medicare UPIN