Basic Information
| Provider Information | |||||||||
| NPI: | 1760594055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REMSEN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | LILLIAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JANICKI | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | LILLIAN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 28 WOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021892542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815348498 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1400 VFW PKWY | ||||||||
| Address2: | SOCIAL WORK OFFICE | ||||||||
| City: | WEST ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021324927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8572036050 | ||||||||
| FaxNumber: | 8572035680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 225X00000X | 660646 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 1041C0700X | 528823 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.