Healthcare Provider Details

I. General information

NPI: 1821273723
Provider Name (Legal Business Name): MONIQUE V. RIBEIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE ROOM 549
BOSTON MA
02115-5711
US

IV. Provider business mailing address

333 LONGWOOD AVE ROOM 549
BOSTON MA
02115-5711
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7040
  • Fax: 617-730-0199
Mailing address:
  • Phone: 617-355-7040
  • Fax: 617-730-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number251078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: