Provider Demographics
NPI:1639217086
Name:MONAGHAN, MICHELLE ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:MONAGHAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4078
Mailing Address - Country:US
Mailing Address - Phone:505-604-2809
Mailing Address - Fax:505-273-7858
Practice Address - Street 1:604 3RD ST NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4078
Practice Address - Country:US
Practice Address - Phone:505-604-2809
Practice Address - Fax:505-273-7858
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor