Provider Demographics
NPI:1952457749
Name:MONSMA, MICHAEL (MSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MONSMA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3373
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-3373
Mailing Address - Country:US
Mailing Address - Phone:304-620-6365
Mailing Address - Fax:304-876-1471
Practice Address - Street 1:41 MADDEX DRIVE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443
Practice Address - Country:US
Practice Address - Phone:304-620-6365
Practice Address - Fax:304-876-1471
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009450011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4483587Medicaid