Healthcare Provider Details

I. General information

NPI: 1669931655
Provider Name (Legal Business Name): MONIQUE PRESBURY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE
CLINTON MD
20735-1608
US

IV. Provider business mailing address

4907 40TH PL
HYATTSVILLE MD
20781-2104
US

V. Phone/Fax

Practice location:
  • Phone: 540-246-2208
  • Fax:
Mailing address:
  • Phone: 540-266-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: