Provider Demographics
NPI:1477600872
Name:LEVY, MONIQUE TERESA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:TERESA
Last Name:LEVY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:TERESA
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2025 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4804
Mailing Address - Country:US
Mailing Address - Phone:559-453-5755
Mailing Address - Fax:559-453-4736
Practice Address - Street 1:2025 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4804
Practice Address - Country:US
Practice Address - Phone:559-453-5755
Practice Address - Fax:559-453-4736
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS233601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 23360OtherSOCIAL WORK