Provider Demographics
NPI:1558823187
Name:ANDERSON, MONIQUE (LSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1802
Mailing Address - Country:US
Mailing Address - Phone:267-701-1145
Mailing Address - Fax:
Practice Address - Street 1:18 CAMPUS BLVD STE 10P
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3245
Practice Address - Country:US
Practice Address - Phone:484-423-3426
Practice Address - Fax:484-432-3401
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker