Healthcare Provider Details

I. General information

NPI: 1114209905
Provider Name (Legal Business Name): MONIQUE C. TASKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

680 CENTRE ST
BROCKTON MA
02302-3308
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7228
  • Fax: 508-941-6401
Mailing address:
  • Phone: 508-941-7885
  • Fax: 508-941-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number216214
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: