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General NPI Number Information
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NPI Number | 1528206273
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Entity Type | Individual
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Provider Name | MARISOL ROXANA MONDACA LPC, LCADC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 232 NORWOOD AVE SUITE 5
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1859
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Country | US
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Telephone | 732-403-1377
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Fax |
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Provider Business Mailing Address
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Address Line | 185 LOCKWOOD AVE
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City | LONG BRANCH
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State | NJ
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Zip | 07740-4804
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Country | US
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Telephone | 732-403-1377
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00135800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00352800
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License Number State | NJ
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