Provider Demographics
NPI:1104949494
Name:MONAT-HALLER, ROSALYN KRAMER (MED)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:KRAMER
Last Name:MONAT-HALLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2103
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-2103
Mailing Address - Country:US
Mailing Address - Phone:843-873-6935
Mailing Address - Fax:843-873-6935
Practice Address - Street 1:145 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-4354
Practice Address - Country:US
Practice Address - Phone:843-873-6935
Practice Address - Fax:843-873-6935
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSCLISW-CP 1960106H00000X
SCLPC 116106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP9960Medicaid