Provider Demographics
NPI:1053986034
Name:MONACO, JOANNA MARIA (LLMSW)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIA
Last Name:MONACO
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21937 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-4086
Mailing Address - Country:US
Mailing Address - Phone:586-612-3278
Mailing Address - Fax:
Practice Address - Street 1:25401 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2240
Practice Address - Country:US
Practice Address - Phone:855-996-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011097281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical