Provider Demographics
NPI:1043254014
Name:MONICATTI, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MONICATTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 ROSELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3978
Mailing Address - Country:US
Mailing Address - Phone:248-514-5371
Mailing Address - Fax:
Practice Address - Street 1:1708 ROSELAND AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3978
Practice Address - Country:US
Practice Address - Phone:248-514-5371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00355590OtherMEDICARE RR
MIP11330004Medicare PIN