Provider Demographics
NPI:1083475909
Name:TERRELL, MONIQUE ANASTASIA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:ANASTASIA
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 KNIGHT STREET
Mailing Address - Street 2:APT 3 REAR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1549
Mailing Address - Country:US
Mailing Address - Phone:401-808-4872
Mailing Address - Fax:
Practice Address - Street 1:90 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1060
Practice Address - Country:US
Practice Address - Phone:401-830-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW03100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health