Provider Demographics
NPI:1649635863
Name:DAUPHIN, MONIQUE ALICE (LMHC)
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:ALICE
Last Name:DAUPHIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COCHRAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4301
Mailing Address - Country:US
Mailing Address - Phone:845-372-5177
Mailing Address - Fax:
Practice Address - Street 1:12 RAYMOND AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2354
Practice Address - Country:US
Practice Address - Phone:845-372-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health