Provider Demographics
NPI:1427811835
Name:LIVINGSTON, SHARRIQUE MONIQUE (LAC)
Entity type:Individual
Prefix:MS
First Name:SHARRIQUE
Middle Name:MONIQUE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2102
Mailing Address - Country:US
Mailing Address - Phone:551-358-2047
Mailing Address - Fax:
Practice Address - Street 1:786 KING GEORGE RD STE 1
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1981
Practice Address - Country:US
Practice Address - Phone:732-902-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00684100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health