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General NPI Number Information
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NPI Number | 1053131227
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Entity Type | Individual
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Provider Name | MONIQUE DURDEN
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Gender | Female
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 10750 SOURWOOD AVE
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City | WALDORF
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State | MD
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Zip | 20603-5753
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Country | US
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Telephone | 203-435-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 15502 EMILY CT
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City | ACCOKEEK
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State | MD
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Zip | 20607-2041
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Country | US
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Telephone | 203-435-8070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904016622
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License Number State | VA
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