Provider Demographics
NPI:1942936240
Name:MONOCACY THERAPY LLC
Entity Type:Organization
Organization Name:MONOCACY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:MAZZARINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, PHD
Authorized Official - Phone:401-525-8858
Mailing Address - Street 1:22611 OLD HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20838-9734
Mailing Address - Country:US
Mailing Address - Phone:401-525-8858
Mailing Address - Fax:
Practice Address - Street 1:22611 OLD HUNDRED RD
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20838-9734
Practice Address - Country:US
Practice Address - Phone:401-525-8858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty