Provider Demographics
NPI:1871000687
Name:DEVINE-HALEY, MONICA ANNE (LCAT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ANNE
Last Name:DEVINE-HALEY
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GARDINER PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1812
Mailing Address - Country:US
Mailing Address - Phone:585-469-4975
Mailing Address - Fax:
Practice Address - Street 1:2376 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3032
Practice Address - Country:US
Practice Address - Phone:585-430-9877
Practice Address - Fax:585-200-3215
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001242221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist