Provider Demographics
NPI:1063999290
Name:MONTEFUSCO, LUIGINA M (LICSW)
Entity type:Individual
Prefix:
First Name:LUIGINA
Middle Name:M
Last Name:MONTEFUSCO
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 1:42 ROGERS ST APT 17
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2698
Mailing Address - Country:US
Mailing Address - Phone:978-852-0736
Mailing Address - Fax:
Practice Address - Street 1:42 ROGERS ST APT 17
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2698
Practice Address - Country:US
Practice Address - Phone:978-852-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical