Provider Demographics
NPI:1902919368
Name:MOROZ-BOURQUE, MONIKA (LCSW)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:MOROZ-BOURQUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3682
Mailing Address - Country:US
Mailing Address - Phone:207-632-5152
Mailing Address - Fax:
Practice Address - Street 1:333 LINCOLN ST STE 217
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3113
Practice Address - Country:US
Practice Address - Phone:207-632-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC43091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME266390099Medicaid
ME266390099Medicaid