Provider Demographics
NPI:1952107195
Name:SMITH, MONIQUE DANA (LMFT, IMH)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:DANA
Last Name:SMITH
Suffix:
Gender:
Credentials:LMFT, IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 SE 47TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9602
Mailing Address - Country:US
Mailing Address - Phone:239-265-0282
Mailing Address - Fax:
Practice Address - Street 1:1222 SE 47TH ST STE 108
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9602
Practice Address - Country:US
Practice Address - Phone:239-265-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22636101YM0800X
FLMT4510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health