Provider Demographics
NPI:1215011622
Name:REMILLARD, ROBERT JAME JR (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAME
Last Name:REMILLARD
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 STRATHMORE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7119
Mailing Address - Country:US
Mailing Address - Phone:508-934-9228
Mailing Address - Fax:
Practice Address - Street 1:59 SAMOSET ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4551
Practice Address - Country:US
Practice Address - Phone:508-934-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10183071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO6048Medicare ID - Type Unspecified