Provider Demographics
NPI:1669935391
Name:MONROE, TARINA LEE (MENTAL HEALTH COUNSE)
Entity type:Individual
Prefix:
First Name:TARINA
Middle Name:LEE
Last Name:MONROE
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:MRS
Other - First Name:TARINA
Other - Middle Name:LEE
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC
Mailing Address - Street 1:60 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3103
Mailing Address - Country:US
Mailing Address - Phone:518-292-5499
Mailing Address - Fax:
Practice Address - Street 1:375 BAY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3012
Practice Address - Country:US
Practice Address - Phone:518-952-9032
Practice Address - Fax:518-252-6445
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25233101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid