Healthcare Provider Details

I. General information

NPI: 1629013479
Provider Name (Legal Business Name): MICHAEL MONACO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/14/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4142 MARINER BLVD STE 121
SPRING HILL FL
34609-2468
US

IV. Provider business mailing address

4142 MARINER BLVD STE 121
SPRING HILL FL
34609-2468
US

V. Phone/Fax

Practice location:
  • Phone: 813-263-6536
  • Fax:
Mailing address:
  • Phone: 813-263-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: