Provider Demographics
NPI:1407205123
Name:JEAN-VENANT, MYRLENE
Entity Type:Individual
Prefix:
First Name:MYRLENE
Middle Name:
Last Name:JEAN-VENANT
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 1:9 KAREN RD
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1922
Mailing Address - Country:US
Mailing Address - Phone:617-240-7226
Mailing Address - Fax:781-933-3283
Practice Address - Street 1:111 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4297
Practice Address - Country:US
Practice Address - Phone:617-284-5164
Practice Address - Fax:617-591-0239
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker