Provider Demographics
NPI:1023393212
Name:MONROE, TIMOTHY MARK (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARK
Last Name:MONROE
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 OLD PLANK RD
Mailing Address - Street 2:PO 98
Mailing Address - City:ONONDAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49264-9707
Mailing Address - Country:US
Mailing Address - Phone:517-628-2287
Mailing Address - Fax:517-629-3421
Practice Address - Street 1:5123 OLD PLANK RD
Practice Address - Street 2:PO 98
Practice Address - City:ONONDAGA
Practice Address - State:MI
Practice Address - Zip Code:49264-9707
Practice Address - Country:US
Practice Address - Phone:517-628-2287
Practice Address - Fax:517-629-3421
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010595401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical