Provider Demographics
NPI:1609981109
Name:MONAT, JANIS SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:SUSAN
Last Name:MONAT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:SUSAN
Other - Last Name:BRAININ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:21 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1539
Mailing Address - Country:US
Mailing Address - Phone:781-784-1706
Mailing Address - Fax:
Practice Address - Street 1:151 MYSTIC AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4632
Practice Address - Country:US
Practice Address - Phone:781-396-1199
Practice Address - Fax:781-396-1439
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107175104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05150Medicare ID - Type Unspecified