Provider Demographics
NPI:1801109137
Name:ANDERSON, MONIQUE (LICSW)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1464
Practice Address - Country:US
Practice Address - Phone:339-222-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1157811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042626179OtherBLUE CROSS/BLUE SHIELD
MA042626179OtherMASSHEALTH
MA042626179OtherUNITED BEHAVIORAL HEALTH
MA042626179OtherHARVARD PILGRIM
042626179OtherCIGNA
MA042626179OtherFALLON