Provider Demographics
NPI:1336909795
Name:SHIM, MONROE DEMETRIUS (CASAC)
Entity Type:Individual
Prefix:MR
First Name:MONROE
Middle Name:DEMETRIUS
Last Name:SHIM
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MEIGS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2496
Mailing Address - Country:US
Mailing Address - Phone:585-532-3011
Mailing Address - Fax:
Practice Address - Street 1:1850 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2532
Practice Address - Country:US
Practice Address - Phone:585-287-5626
Practice Address - Fax:585-287-5628
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37484101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)