Healthcare Provider Details

I. General information

NPI: 1811719347
Provider Name (Legal Business Name): EMILY MONROE LAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N STATE RT 17 STE 100
PARAMUS NJ
07652-2648
US

IV. Provider business mailing address

181 CENTRAL AVE
ENGLEWOOD NJ
07631-2218
US

V. Phone/Fax

Practice location:
  • Phone: 732-982-2888
  • Fax:
Mailing address:
  • Phone: 201-310-7360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00728600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: