Basic Information
Provider Information
NPI: 1003292582
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONACO
FirstName: MOLLY
MiddleName: BETH
NamePrefix:  
NameSuffix:  
Credential: BCBA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 FAIRWAY DR
Address2: #102
City: DEERFIELD BEACH
State: FL
PostalCode: 334411814
CountryCode: US
TelephoneNumber: 8888809270
FaxNumber:  
Practice Location
Address1: 8550 UNITED PLAZA BLVD STE 702N
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708090200
CountryCode: US
TelephoneNumber: 8888809270
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/06/2015
LastUpdateDate: 08/06/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


Home