Provider Demographics
NPI:1205646957
Name:KOLACZEWSKA, MONIKA
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:KOLACZEWSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SAGECREST CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8668
Mailing Address - Country:US
Mailing Address - Phone:321-830-0982
Mailing Address - Fax:
Practice Address - Street 1:590 SOLUTIONS WAY
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3627
Practice Address - Country:US
Practice Address - Phone:321-684-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health