Provider Demographics
NPI:1629130646
Name:KUMINS, JO ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JO ANN
Middle Name:
Last Name:KUMINS
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 1:1 CHARLES ST S
Mailing Address - Street 2:3C
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5431
Mailing Address - Country:US
Mailing Address - Phone:781-237-7979
Mailing Address - Fax:
Practice Address - Street 1:11 RIVER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2098
Practice Address - Country:US
Practice Address - Phone:781-237-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10207531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO6044Medicare ID - Type UnspecifiedPROVIDER ID