Provider Demographics
NPI:1336284850
Name:MONAGHAN, PAMELLA D (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELLA
Middle Name:D
Last Name:MONAGHAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-1342
Mailing Address - Country:US
Mailing Address - Phone:517-627-7169
Mailing Address - Fax:
Practice Address - Street 1:234 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4215
Practice Address - Country:US
Practice Address - Phone:517-337-6545
Practice Address - Fax:517-337-3010
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062678104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC36169008Medicare ID - Type Unspecified
MIP56993Medicare UPIN