Individual
DR. JEREMY MARK RIDENOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
25 MAIN STREET, STOCKBRIDGE, MA 01262-0962
(903) 258-5876
(413) 298-4020
Mailing address
25 MAIN STREET, PO BOX 962, STOCKBRIDGE, MA 01262-0962
(413) 931-5283
(413) 298-4020
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
048.0117056
VT
103T00000X
Psychologist
Primary
10216
MA
Other
Enumeration date
02/15/2016
Last updated
04/21/2019
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