Provider Demographics
NPI:1639745409
Name:MCEACHERN, MONTINIQUE DENICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONTINIQUE
Middle Name:DENICE
Last Name:MCEACHERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 LORRAINE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3257
Mailing Address - Country:US
Mailing Address - Phone:315-443-3023
Mailing Address - Fax:
Practice Address - Street 1:3828 LANCASTER AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2355
Practice Address - Country:US
Practice Address - Phone:315-443-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist