Provider Demographics
NPI:1962979740
Name:BURKE, MONIQUE TREMBLAY (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:TREMBLAY
Last Name:BURKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 STONEHEDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1251
Mailing Address - Country:US
Mailing Address - Phone:603-898-5308
Mailing Address - Fax:
Practice Address - Street 1:16 STONEHEDGE RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1251
Practice Address - Country:US
Practice Address - Phone:603-898-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10270361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical