Doctor Name: | TIMOTHY MARK MONROE |
NPI Number: | 1023393212 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW, LMSW |
License Number: | 6801059540 |
Business Practice Address: | 5123 Old Plank Rd Po 98 Onondaga, MI - 492649707 |
Business Phone Number: | 5176282287 |
Business Fax Number: | 5176293421 |
Mailing Address: | 5123 Old Plank Rd, Po 98 ONONDAGA |
State: | MI |
Postal Code: | 492649707 |
Phone Number: | 5176282287 |
Fax Number: | 5176293421 |
NPI Enumeration Date: | 10/19/2011 |
NPI Last Update Date: | 10/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801059540 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |