Provider Demographics
NPI:1750634523
Name:PARHAM, MONIQUE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:L
Last Name:PARHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13325 GUY R BREWER BLVD
Mailing Address - Street 2:RM 118
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2941
Mailing Address - Country:US
Mailing Address - Phone:718-276-2508
Mailing Address - Fax:
Practice Address - Street 1:13325 GUY R BREWER BLVD
Practice Address - Street 2:RM 118
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2941
Practice Address - Country:US
Practice Address - Phone:718-276-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080262-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker