Provider Demographics
NPI:1861617524
Name:REMILLARD, CHARLENE A (LICSW)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:REMILLARD
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-0374
Mailing Address - Country:US
Mailing Address - Phone:617-529-6353
Mailing Address - Fax:508-880-6848
Practice Address - Street 1:12 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1500
Practice Address - Country:US
Practice Address - Phone:508-473-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110804104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker