Healthcare Provider Details

I. General information

NPI: 1427875657
Provider Name (Legal Business Name): MONIROT SAN SOLEAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 EAST MOUNTAIN ST SECOND FLOOR
WORCESTER MA
01606
US

IV. Provider business mailing address

18 ONSET ST
WORCESTER MA
01604-2035
US

V. Phone/Fax

Practice location:
  • Phone: 508-450-1606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: