Provider Demographics
NPI:1164762696
Name:BROWN FAUST, MONIQUE D (LMHC MCAP SAP CAD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:D
Last Name:BROWN FAUST
Suffix:
Gender:F
Credentials:LMHC MCAP SAP CAD
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:BROWN FAUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LMHC MCAP SAP
Mailing Address - Street 1:31 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6155
Mailing Address - Country:US
Mailing Address - Phone:561-899-9140
Mailing Address - Fax:561-331-2715
Practice Address - Street 1:31 W 20TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6155
Practice Address - Country:US
Practice Address - Phone:561-899-9140
Practice Address - Fax:561-331-2715
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100321101YA0400X
171M00000X, 172V00000X
FLMH18952101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112621400Medicaid