Healthcare Provider Details

I. General information

NPI: 1306977343
Provider Name (Legal Business Name): LINDA JEAN MONAHAN LCSW-R CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N OCEAN AVE SUITE LL1
PATCHOGUE NY
11772-2015
US

IV. Provider business mailing address

110 N OCEAN AVE SUITE LL1
PATCHOGUE NY
11772-2015
US

V. Phone/Fax

Practice location:
  • Phone: 631-561-8382
  • Fax: 631-727-2667
Mailing address:
  • Phone: 631-561-8382
  • Fax: 631-727-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number068054
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: