Basic Information
Provider Information
NPI: 1134446040
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONROE
FirstName: LINDA
MiddleName: S
NamePrefix: MS.
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 223
Address2:  
City: SOUTH BAY
State: FL
PostalCode: 334930223
CountryCode: US
TelephoneNumber: 5615160068
FaxNumber:  
Practice Location
Address1: 1639 FORUM PL
Address2: SUITE 7
City: WEST PALM BEACH
State: FL
PostalCode: 334012330
CountryCode: US
TelephoneNumber: 5617128821
FaxNumber: 5617128070
Other Information
ProviderEnumerationDate: 05/02/2010
LastUpdateDate: 05/02/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X10101YM0800XFLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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