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General NPI Number Information
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NPI Number | 1104402148
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Entity Type | Organization
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Legal Business Name | ASHLEY MONCK LCSW LLC
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Dates
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Enumeration Date | 03/21/2021
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 30 DEEPWOOD DR
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City | BETHEL
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State | CT
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Zip | 06801-1267
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Country | US
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Telephone | 203-302-9378
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Fax |
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Provider Business Mailing Address
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Address Line | 54 DANBURY RD STE 337
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City | RIDGEFIELD
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State | CT
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Zip | 06877-4019
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Country | US
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Telephone | 203-302-9378
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | ASHLEY BRUCKENTHAL
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Credential |
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Telephone | 203-302-9378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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