Provider Demographics
NPI:1922567031
Name:MORICEAU, VALERIE PATRICIA (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:PATRICIA
Last Name:MORICEAU
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1940
Mailing Address - Country:US
Mailing Address - Phone:617-592-3738
Mailing Address - Fax:
Practice Address - Street 1:111 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1940
Practice Address - Country:US
Practice Address - Phone:617-592-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1110051041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA111005OtherSOCIAL WORK LICENSE