Provider Demographics
NPI:1144781733
Name:ROACH, MONIQUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25920 IRIS AVE STE 13A
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1658
Mailing Address - Country:US
Mailing Address - Phone:909-581-4854
Mailing Address - Fax:951-405-6454
Practice Address - Street 1:6845 INDIANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4224
Practice Address - Country:US
Practice Address - Phone:909-581-4854
Practice Address - Fax:951-405-6454
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA882901041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical