Provider Demographics
NPI:1790918456
Name:LEVERMORE, MONIQUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name:LEVERMORE
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 1:15715 S DIXIE HWY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1800
Mailing Address - Country:US
Mailing Address - Phone:786-293-0922
Mailing Address - Fax:786-293-0923
Practice Address - Street 1:15715 S DIXIE HWY
Practice Address - Street 2:SUITE 404
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1800
Practice Address - Country:US
Practice Address - Phone:786-293-0922
Practice Address - Fax:786-293-0923
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 0005628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54205OtherBLUE CROSS BLUE SHIELD