Provider Demographics
NPI:1104584762
Name:NANTEGE, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:NANTEGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EASTBROOK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2083
Mailing Address - Country:US
Mailing Address - Phone:857-293-5020
Mailing Address - Fax:
Practice Address - Street 1:30 EASTBROOK RD STE 101
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2083
Practice Address - Country:US
Practice Address - Phone:857-293-5020
Practice Address - Fax:857-226-8772
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker