Provider Demographics
NPI:1982260030
Name:MICHAEL MONSMA LLC
Entity Type:Organization
Organization Name:MICHAEL MONSMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MONSMA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-620-6365
Mailing Address - Street 1:595 CHERRY HILL FARM DRIVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430
Mailing Address - Country:US
Mailing Address - Phone:304-620-6365
Mailing Address - Fax:
Practice Address - Street 1:41 MADDEX DRIVE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443
Practice Address - Country:US
Practice Address - Phone:304-620-6365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty