Provider Demographics
NPI:1740424795
Name:LOVECKY, MONICA MICHELLE (DIRECTOR/TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:MICHELLE
Last Name:LOVECKY
Suffix:
Gender:F
Credentials:DIRECTOR/TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-0819
Mailing Address - Country:US
Mailing Address - Phone:207-934-4489
Mailing Address - Fax:
Practice Address - Street 1:62 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064
Practice Address - Country:US
Practice Address - Phone:207-934-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME215863222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME116320000Medicare PIN