Healthcare Provider Details

I. General information

NPI: 1912204686
Provider Name (Legal Business Name): GLENN M MEUNIER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 PLYMOUTH ST SUITE 100
HALIFAX MA
02338-1342
US

IV. Provider business mailing address

362 N BEDFORD ST
EAST BRIDGEWATER MA
02333-1148
US

V. Phone/Fax

Practice location:
  • Phone: 781-422-2900
  • Fax: 781-422-2905
Mailing address:
  • Phone: 508-350-2450
  • Fax: 508-350-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number115926
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: