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General NPI Number Information
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NPI Number | 1700168325
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Entity Type | Individual
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Provider Name | MICHELLE COLLEEN MONK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/10/2011
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 3662 AVALON PARK EAST BLVD STE 2022
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City | ORLANDO
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State | FL
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Zip | 32828-7760
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Country | US
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Telephone | 312-246-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 3662 AVALON PARK EAST BLVD STE 2022
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City | ORLANDO
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State | FL
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Zip | 32828-7760
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Country | US
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Telephone | 312-246-0814
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10064
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071005156
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License Number State | IL
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