Provider Demographics
NPI:1639105885
Name:HERRICK OSTROFF, MONIKA E (LICSW)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:E
Last Name:HERRICK OSTROFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:
Other - Last Name:OSTROFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:2 SCAMMON LN
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4206
Mailing Address - Country:US
Mailing Address - Phone:603-772-5349
Mailing Address - Fax:603-217-5910
Practice Address - Street 1:1320 CENTRE ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2400
Practice Address - Country:US
Practice Address - Phone:617-558-1881
Practice Address - Fax:603-217-5910
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422923Medicaid
NH14Y001391NH01OtherANTHEM OF NH
MAS400644996OtherMEDICARE MA