Provider Demographics
NPI:1790255909
Name:ROBERTS, MONIQUE (MHP-LP)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MHP-LP
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:C
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHP-LP
Mailing Address - Street 1:1135 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3722
Mailing Address - Country:US
Mailing Address - Phone:917-960-1209
Mailing Address - Fax:
Practice Address - Street 1:19 W 34TH ST PH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-947-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP14186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health