Provider Demographics
NPI:1114490869
Name:FEAL, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:FEAL
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 1:2675 HORSESHOE DR S STE 404
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6155
Mailing Address - Country:US
Mailing Address - Phone:800-217-9289
Mailing Address - Fax:888-751-4019
Practice Address - Street 1:2675 HORSESHOE DR S STE 404
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6155
Practice Address - Country:US
Practice Address - Phone:800-217-9289
Practice Address - Fax:888-751-4019
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18--71252106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty