MEDICARE: AMY MONICATTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301011291	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00355590	OTHER	MI	MEDICARE RR

General Provider Information

NPI Number	:	1043254014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MONICATTI

Provider Business Mailing Address
First Line	:	1708 ROSELAND AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3978
Country	:	US
Telephone Number	:	248-514-5371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 ROSELAND AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3978
Country	:	US
Telephone Number	:	248-514-5371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	02/19/2008

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