Provider Demographics
NPI:1407292626
Name:BARNETT, MONIQUE LATRICE (BS, MS, LSST)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:LATRICE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:BS, MS, LSST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 N STEPHENSON HWY
Mailing Address - Street 2:APT 79
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1544
Mailing Address - Country:US
Mailing Address - Phone:248-291-4117
Mailing Address - Fax:
Practice Address - Street 1:2925 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4825
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2434979171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator