Provider Demographics
NPI:1215068895
Name:LANDSBERG, ANN S (MED, LCSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:S
Last Name:LANDSBERG
Suffix:
Gender:F
Credentials:MED, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ELIOT ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2737
Mailing Address - Country:US
Mailing Address - Phone:617-413-7183
Mailing Address - Fax:
Practice Address - Street 1:22 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:781-306-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2006301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical