Provider Demographics
NPI:1982748927
Name:KITTLER, JANYCE G (LICSW)
Entity Type:Individual
Prefix:
First Name:JANYCE
Middle Name:G
Last Name:KITTLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 BLACK POND HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1022
Mailing Address - Country:US
Mailing Address - Phone:781-659-4807
Mailing Address - Fax:
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:617-968-4059
Practice Address - Fax:617-471-6327
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10303361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA738OtherLADC 1 LIC ALC & DRUG COU
2237294OtherFIRST HEALTH ID #
MAHP2178814OtherHARVARD PILGRIM PROV ID #
MAPO8560OtherBLUE CROSS BLUE SHIELD PR
MA1030336OtherLICSW
MA494997OtherTUFTS HEALTH PLAN PROV ID
11522997OtherCAQH ID #
MA738OtherLADC 1 LIC ALC & DRUG COU