Provider Demographics
NPI:1972547982
Name:MONTICUE, MICHAEL RAYMOND (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:MONTICUE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:850 HOSPITAL RD STE 2200
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3663
Practice Address - Country:US
Practice Address - Phone:724-464-0270
Practice Address - Fax:724-464-0273
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0153531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical