Provider Demographics
NPI:1619909603
Name:PAGE, FUSAKO INOUE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:FUSAKO
Middle Name:INOUE
Last Name:PAGE
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 1:16 SAINT JAMES RD.
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906
Mailing Address - Country:US
Mailing Address - Phone:781-910-4483
Mailing Address - Fax:
Practice Address - Street 1:6 PLEASANT ST.
Practice Address - Street 2:SUITE 314
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-910-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10322071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1855514Medicaid
MA1855514Medicaid