Provider Demographics
NPI:1578022158
Name:SAMANO, MONIQUE ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ANN
Last Name:SAMANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HERITAGE DR STE 261
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2574
Mailing Address - Country:US
Mailing Address - Phone:734-778-0663
Mailing Address - Fax:
Practice Address - Street 1:1 HERITAGE DR STE 261
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2574
Practice Address - Country:US
Practice Address - Phone:734-778-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011071461041C0700X
MI68011025571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical