MEDICARE: DR. JOSEPH MICHAEL MONSERRAT PSYD.

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	68 016543	NY

General Provider Information

NPI Number	:	1821041062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MICHAEL MONSERRAT PSYD.

Provider Business Mailing Address
First Line	:	3 LEAR JET LN
Second Line	:	SUITE 105
City	:	LATHAM
State	:	NY
Zip	:	12110-2314
Country	:	US
Telephone Number	:	518-785-3614
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 LEAR JET LN
Second Line	:	SUITE 105
City	:	LATHAM
State	:	NY
Zip	:	12110-2314
Country	:	US
Telephone Number	:	518-785-3614
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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