Provider Demographics
NPI:1902636327
Name:MONAGHAN, BENJAMIN DAVID (LMSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DAVID
Last Name:MONAGHAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 BROADWAY APT 2A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5864
Mailing Address - Country:US
Mailing Address - Phone:607-342-3240
Mailing Address - Fax:
Practice Address - Street 1:191 JORALEMON ST FL 14
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4353
Practice Address - Country:US
Practice Address - Phone:607-342-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123967-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker