Provider Demographics
NPI:1780660894
Name:SPINA, MONIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:SPINA
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 1:655 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1543
Mailing Address - Country:US
Mailing Address - Phone:207-283-1407
Mailing Address - Fax:207-284-6291
Practice Address - Street 1:655 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1543
Practice Address - Country:US
Practice Address - Phone:207-283-1407
Practice Address - Fax:207-284-6291
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC81531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME272058099Medicaid
ME272058099Medicaid