Provider Demographics
NPI:1033729843
Name:MONARCH MENTAL HEALTH & WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:MONARCH MENTAL HEALTH & WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDENIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDESIR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:954-560-7124
Mailing Address - Street 1:401 E LAS OLAS BLVD STE 130-146
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2210
Mailing Address - Country:US
Mailing Address - Phone:954-560-7124
Mailing Address - Fax:954-206-0500
Practice Address - Street 1:648 NW 183RD STREET
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-3331
Practice Address - Country:US
Practice Address - Phone:954-399-6004
Practice Address - Fax:954-206-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1952715682OtherNPI
FL1447695184OtherNPI