Provider Demographics
NPI:1932061645
Name:MIDY, MENARDINE
Entity type:Individual
Prefix:
First Name:MENARDINE
Middle Name:
Last Name:MIDY
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 1:46 MARION ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2437
Mailing Address - Country:US
Mailing Address - Phone:781-300-3686
Mailing Address - Fax:
Practice Address - Street 1:19 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6898
Practice Address - Country:US
Practice Address - Phone:508-690-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty