Provider Demographics
NPI:1801856265
Name:LAVERY, MONICA HAUCK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:HAUCK
Last Name:LAVERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5205 COFFEE TREE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4553
Mailing Address - Country:US
Mailing Address - Phone:919-791-5346
Mailing Address - Fax:919-782-8731
Practice Address - Street 1:2000 YONKERS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2258
Practice Address - Country:US
Practice Address - Phone:919-791-5346
Practice Address - Fax:919-782-8731
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02469OtherBLUE CROSS/BLUE SHIELD
NC6003408Medicaid