Healthcare Provider Details

I. General information

NPI: 1487611414
Provider Name (Legal Business Name): THERESA ELENA MONUTEAUX MSW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SULLIVAN DR
FALL RIVER MA
02721-6812
US

IV. Provider business mailing address

101 SULLIVAN DR
FALL RIVER MA
02721-6812
US

V. Phone/Fax

Practice location:
  • Phone: 508-523-4792
  • Fax: 508-646-9556
Mailing address:
  • Phone: 508-523-4792
  • Fax: 508-646-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1019524
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1035720
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBEACON HEALTH
# 2
IdentifierP06134
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBC
# 3
Identifier014756
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerVALUE OPTIONS
# 4
Identifier101954
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS TOTAL HEALTH
# 5
Identifier408300
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMAGELLAN
# 6
Identifier267988
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerBCRI
# 7
Identifier014756
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHARVARD PILGRIM
# 8
Identifier1890964
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMA BEHAVIORA HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: