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General NPI Number Information
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NPI Number | 1144781733
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Entity Type | Individual
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Provider Name | MONIQUE ROACH LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 6845 INDIANA AVE STE 101
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City | RIVERSIDE
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State | CA
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Zip | 92506-4224
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Country | US
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Telephone | 909-581-4854
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Fax | 951-405-6454
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Provider Business Mailing Address
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Address Line | 25920 IRIS AVE STE 13A
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City | MORENO VALLEY
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State | CA
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Zip | 92551-1658
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Country | US
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Telephone | 909-581-4854
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Fax | 951-405-6454
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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 | 88290
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 88290
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License Number State | CA
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