Provider Demographics
NPI:1205199056
Name:DORCELY, MONIQUE EVELYNE
Entity Type:Individual
Prefix:MR
First Name:MONIQUE
Middle Name:EVELYNE
Last Name:DORCELY
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 1:138 KENT RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3316
Mailing Address - Country:US
Mailing Address - Phone:917-402-4948
Mailing Address - Fax:
Practice Address - Street 1:138 KENT RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3316
Practice Address - Country:US
Practice Address - Phone:917-402-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health