Healthcare Provider Details

I. General information

NPI: 1326520628
Provider Name (Legal Business Name): MONIQUE BERTIC-COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 GEORGE ST
MEDFORD MA
02155-5440
US

IV. Provider business mailing address

133 GEORGE ST
MEDFORD MA
02155-5440
US

V. Phone/Fax

Practice location:
  • Phone: 857-204-6242
  • Fax:
Mailing address:
  • Phone: 857-204-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118088
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: