Provider Demographics
NPI:1801176938
Name:PRINCE, MONIQUE MARIE COLLEEN (MSW, LICSW)
Entity type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:MARIE COLLEEN
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-0005
Mailing Address - Country:US
Mailing Address - Phone:603-370-7692
Mailing Address - Fax:
Practice Address - Street 1:32 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2544
Practice Address - Country:US
Practice Address - Phone:603-370-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW 217325104100000X
MEMC14416104100000X
NH19311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE400228686OtherMEDICARE
NH435407000Medicaid