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General NPI Number Information
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NPI Number | 1720195274
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Entity Type | Individual
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Provider Name | MONIQUE M LITERSKY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 09/04/2016
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Provider Practice Location Address
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Address Line | 2206A FOREST AVE
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City | TWO RIVERS
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State | WI
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Zip | 54241-1912
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Country | US
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Telephone | 920-323-5354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 213
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City | TWO RIVERS
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State | WI
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Zip | 54241-0213
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Country | US
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Telephone | 920-323-5354
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7204-123
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License Number State | WI
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