Provider Demographics
NPI:1700302247
Name:DEAN, MONIQUE DASHAI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:DASHAI
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:D
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4193 FLAT ROCK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-7113
Mailing Address - Country:US
Mailing Address - Phone:562-955-9630
Mailing Address - Fax:
Practice Address - Street 1:4193 FLAT ROCK DR STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7113
Practice Address - Country:US
Practice Address - Phone:562-955-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83521101YM0800X
225400000X, 390200000X
CA1013021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program