Doctor Name: | MARISOL ROXANA MONDACA |
NPI Number: | 1528206273 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, LCADC |
License Number: | 37LC00135800 |
Business Practice Address: | 232 Norwood Ave Suite 5 West Long Branch, NJ - 077641859 |
Business Phone Number: | 7324031377 |
Business Fax Number: | |
Mailing Address: | 185 Lockwood Ave, LONG BRANCH |
State: | NJ |
Postal Code: | 077404804 |
Phone Number: | 7324031377 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2009 |
NPI Last Update Date: | 02/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 37LC00135800 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |