Provider Demographics
NPI:1609529288
Name:MONICA JAY, MSW, LISWS, LLC
Entity Type:Organization
Organization Name:MONICA JAY, MSW, LISWS, LLC
Other - Org Name:MONICA JAY, MSW, LISWS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:419-680-0937
Mailing Address - Street 1:112 S COLLINWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4528
Mailing Address - Country:US
Mailing Address - Phone:419-680-0937
Mailing Address - Fax:567-249-0067
Practice Address - Street 1:409 S FRONT ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3072
Practice Address - Country:US
Practice Address - Phone:419-680-0937
Practice Address - Fax:567-249-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty