Provider Demographics
NPI:1922249069
Name:MONROE, KATHI (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHI
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-8 BOUNDARY AVENUE
Mailing Address - Street 2:
Mailing Address - City:S FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:516-790-8158
Mailing Address - Fax:516-249-8213
Practice Address - Street 1:47 BOUNDARY AVE STE 8
Practice Address - Street 2:
Practice Address - City:S FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4450
Practice Address - Country:US
Practice Address - Phone:516-790-8158
Practice Address - Fax:516-249-8213
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002501171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist