Healthcare Provider Details

I. General information

NPI: 1023382595
Provider Name (Legal Business Name): JOHN JOSEPH MONAHAN L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MISTY MORN LN
EWING NJ
08638-1814
US

IV. Provider business mailing address

24 MISTY MORN LN
EWING NJ
08638-1814
US

V. Phone/Fax

Practice location:
  • Phone: 609-771-4195
  • Fax:
Mailing address:
  • Phone: 609-771-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00657700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: