Healthcare Provider Details

I. General information

NPI: 1083475909
Provider Name (Legal Business Name): MONIQUE ANASTASIA TERRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ STE 131C
PROVIDENCE RI
02906-5154
US

IV. Provider business mailing address

77 KNIGHT ST APT 3
PROVIDENCE RI
02909-1549
US

V. Phone/Fax

Practice location:
  • Phone: 401-787-2792
  • Fax: 401-679-6170
Mailing address:
  • Phone: 401-808-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW03100
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: