Provider Demographics
NPI:1790805752
Name:KAIM, MONIQUE CAMILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:CAMILLE
Last Name:KAIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DAPHNE LN
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1602
Mailing Address - Country:US
Mailing Address - Phone:917-913-6471
Mailing Address - Fax:
Practice Address - Street 1:6 DAPHNE LN
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1602
Practice Address - Country:US
Practice Address - Phone:917-913-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013230-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist