Provider Demographics
NPI:1720195274
Name:LITERSKY, MONIQUE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:M
Last Name:LITERSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:MARIE
Other - Last Name:KNAUS-LITERSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-0213
Mailing Address - Country:US
Mailing Address - Phone:920-323-5354
Mailing Address - Fax:
Practice Address - Street 1:2206A FOREST AVE
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-1912
Practice Address - Country:US
Practice Address - Phone:920-323-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7204-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40975200Medicaid
Q55081Medicare UPIN