Provider Demographics
NPI:1467923557
Name:BROWN, MONIQUE J (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2747
Mailing Address - Country:US
Mailing Address - Phone:225-245-9070
Mailing Address - Fax:
Practice Address - Street 1:415 COURT ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2747
Practice Address - Country:US
Practice Address - Phone:225-245-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator