Provider Demographics
NPI:1356692826
Name:REMY-VALEUS, MIRDITH
Entity type:Individual
Prefix:
First Name:MIRDITH
Middle Name:
Last Name:REMY-VALEUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRDITH
Other - Middle Name:
Other - Last Name:REMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 STEARNS AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2132
Mailing Address - Country:US
Mailing Address - Phone:347-869-1746
Mailing Address - Fax:
Practice Address - Street 1:425 PLEASANT ST STE 102
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2533
Practice Address - Country:US
Practice Address - Phone:347-869-1746
Practice Address - Fax:781-885-7652
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health