Provider Demographics
NPI:1124340252
Name:ANDERSON, JANICE DULUDE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:DULUDE
Last Name:ANDERSON
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 1:44 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4228
Mailing Address - Country:US
Mailing Address - Phone:508-587-0815
Mailing Address - Fax:508-580-0837
Practice Address - Street 1:686 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2444
Practice Address - Country:US
Practice Address - Phone:508-587-0815
Practice Address - Fax:508-580-0837
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1071051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical