Provider Demographics
NPI:1760594055
Name:REMSEN, MICHELLE LILLIAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LILLIAN
Last Name:REMSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LILLIAN
Other - Last Name:JANICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:28 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2542
Mailing Address - Country:US
Mailing Address - Phone:781-534-8498
Mailing Address - Fax:
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:SOCIAL WORK OFFICE
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:857-203-6050
Practice Address - Fax:857-203-5680
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X
MA660646225X00000X
MA5288231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist