Provider Demographics
NPI:1528779923
Name:FLEURY, MEDGINE
Entity type:Individual
Prefix:MS
First Name:MEDGINE
Middle Name:
Last Name:FLEURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1621
Mailing Address - Country:US
Mailing Address - Phone:561-843-6556
Mailing Address - Fax:
Practice Address - Street 1:141 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1621
Practice Address - Country:US
Practice Address - Phone:561-843-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS53068771104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty