Provider Demographics
NPI:1235663048
Name:GARDNER-SCOTT, MONIQUE YVONNE (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:YVONNE
Last Name:GARDNER-SCOTT
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 W ADDISON ST APT 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4715
Mailing Address - Country:US
Mailing Address - Phone:269-532-2903
Mailing Address - Fax:
Practice Address - Street 1:2578 BROADWAY # 607
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5642
Practice Address - Country:US
Practice Address - Phone:212-284-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional