=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588378129
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONIQUE ROSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2023
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4228 S BROAD ST
-----------------------------------------------------
City | HAMILTON TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08620-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-475-2560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 471
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-0471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-357-7568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 45SC06562100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------