Healthcare Provider Details

I. General information

NPI: 1245312412
Provider Name (Legal Business Name): CHRISTY LOUISE MONAGHAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 PASEO REYES DR
ST AUGUSTINE FL
32095-8464
US

IV. Provider business mailing address

8135 NW 51ST ST
GAINESVILLE FL
32653-6159
US

V. Phone/Fax

Practice location:
  • Phone: 904-755-6592
  • Fax:
Mailing address:
  • Phone: 904-755-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: