Provider Demographics
NPI:1114356938
Name:MEDLICOTT, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MEDLICOTT
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 1:28 PLAYERS CIR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3806
Mailing Address - Country:US
Mailing Address - Phone:732-935-9445
Mailing Address - Fax:
Practice Address - Street 1:28 PLAYERS CIR
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3806
Practice Address - Country:US
Practice Address - Phone:732-935-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05032600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker