Provider Demographics
NPI:1376733576
Name:MONROE, CLAUDIA ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:ANNE
Last Name:MONROE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:BROCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14716-0643
Mailing Address - Country:US
Mailing Address - Phone:716-792-5000
Mailing Address - Fax:716-792-5001
Practice Address - Street 1:148 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCTON
Practice Address - State:NY
Practice Address - Zip Code:14716-9750
Practice Address - Country:US
Practice Address - Phone:716-792-5000
Practice Address - Fax:716-792-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010920-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist