Provider Demographics
NPI:1104402148
Name:ASHLEY MONCK LCSW LLC
Entity type:Organization
Organization Name:ASHLEY MONCK LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCKENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-302-9378
Mailing Address - Street 1:54 DANBURY RD STE 337
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4019
Mailing Address - Country:US
Mailing Address - Phone:203-302-9378
Mailing Address - Fax:
Practice Address - Street 1:30 DEEPWOOD DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1267
Practice Address - Country:US
Practice Address - Phone:203-302-9378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-21
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1295281178Medicaid