Provider Demographics
NPI:1134206410
Name:SAX, JANA (LICSW)
Entity type:Individual
Prefix:MS
First Name:JANA
Middle Name:
Last Name:SAX
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 1:83 COMMONWEALTH PARK W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1025
Mailing Address - Country:US
Mailing Address - Phone:617-332-9521
Mailing Address - Fax:
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3848
Practice Address - Country:US
Practice Address - Phone:781-395-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASAP23703Medicare ID - Type Unspecified