Provider Demographics
NPI:1497474258
Name:MONROY, LETICIA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:MONROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 TOMAHAWK DR E
Mailing Address - Street 2:
Mailing Address - City:CONESTOGA
Mailing Address - State:PA
Mailing Address - Zip Code:17516-9715
Mailing Address - Country:US
Mailing Address - Phone:717-715-3393
Mailing Address - Fax:
Practice Address - Street 1:731 N DUKE ST APT 1
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2012
Practice Address - Country:US
Practice Address - Phone:717-715-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional