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General NPI Number Information
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NPI Number | 1497497689
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Entity Type | Organization
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Legal Business Name | MONIQUE PROTO, LLC
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 2 LINSLEY ST
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2500
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Country | US
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Telephone | 203-640-7454
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Fax | 203-889-5425
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Provider Business Mailing Address
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Address Line | 125 MAPLE ST
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City | EAST HAVEN
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State | CT
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Zip | 06512-1111
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Country | US
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Telephone | 203-640-7454
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Fax | 203-889-5425
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Authorized Official
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Title or Position | OWNER
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Name | MONIQUE PROTO
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Credential | LPC, CLAT
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Telephone | 203-640-7454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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