Provider Demographics
NPI:1306124698
Name:VANTINE, MONICA (LCSW-R)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:VANTINE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LINDSEY
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:6666 E QUAKER ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2547
Mailing Address - Country:US
Mailing Address - Phone:716-226-6873
Mailing Address - Fax:
Practice Address - Street 1:6666 E QUAKER ST STE 4
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2547
Practice Address - Country:US
Practice Address - Phone:716-226-6873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072297104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker