Provider Demographics
NPI:1942398318
Name:O. MONROE, MARA (MA, LPC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:
Last Name:O. MONROE
Suffix:
Gender:F
Credentials:MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-22 17TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2128
Mailing Address - Country:US
Mailing Address - Phone:201-919-6184
Mailing Address - Fax:
Practice Address - Street 1:175 N MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-1638
Practice Address - Country:US
Practice Address - Phone:551-800-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002187101YM0800X
NJ37PC00526200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health