Provider Demographics
NPI:1568933588
Name:DIMONACO, JANIS SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:SUSAN
Last Name:DIMONACO
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 1:181 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4007
Mailing Address - Country:US
Mailing Address - Phone:714-803-0284
Mailing Address - Fax:561-847-2914
Practice Address - Street 1:32 HAMDEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:11937
Practice Address - Country:US
Practice Address - Phone:413-732-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100-9091041C0700X
MA100909-SW-LICSW1041C0700X
MA9091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical