Provider Demographics
NPI:1164584850
Name:RAWN, MONICA JEANNE (MSS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:JEANNE
Last Name:RAWN
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SAGAMORE WAY S
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2345
Mailing Address - Country:US
Mailing Address - Phone:516-433-5150
Mailing Address - Fax:516-938-6218
Practice Address - Street 1:23 SAGAMORE WAY S
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2345
Practice Address - Country:US
Practice Address - Phone:516-433-5150
Practice Address - Fax:516-938-6218
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR000588-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical