Healthcare Provider Details

I. General information

NPI: 1841363785
Provider Name (Legal Business Name): MONIQUE WALKER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 STATE ST
SPRINGFIELD MA
01109-4101
US

IV. Provider business mailing address

49 ELDRIDGE ST
CHICOPEE MA
01013-2937
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6661
  • Fax:
Mailing address:
  • Phone: 413-297-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number217039
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: