Healthcare Provider Details

I. General information

NPI: 1639105885
Provider Name (Legal Business Name): MONIKA E HERRICK OSTROFF L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIKA OSTROFF L.I.C.S.W.

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CENTRE ST STE 101
NEWTON MA
02459-2400
US

IV. Provider business mailing address

2 SCAMMON LN
EXETER NH
03833-4206
US

V. Phone/Fax

Practice location:
  • Phone: 617-558-1881
  • Fax: 603-217-5910
Mailing address:
  • Phone: 603-772-5349
  • Fax: 603-217-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1096
License Number StateNH

VII. Legacy identifiers

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

# 1
Identifier30422923
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
Identifier14Y001391NH01
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerANTHEM OF NH
# 3
IdentifierS400644996
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMEDICARE MA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: