Provider Demographics
NPI:1144991068
Name:HOLSEY-HYMAN, MONIQUE HOLSEY- (EDD, LCSW- R , MSW)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:HOLSEY-
Last Name:HOLSEY-HYMAN
Suffix:
Gender:F
Credentials:EDD, LCSW- R , MSW
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:HOLSEY-
Other - Last Name:HYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, LCSW- R , MSW
Mailing Address - Street 1:6514 LOGANBURY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6455
Mailing Address - Country:US
Mailing Address - Phone:718-414-5987
Mailing Address - Fax:
Practice Address - Street 1:6514 LOGANBURY DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6455
Practice Address - Country:US
Practice Address - Phone:718-414-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052881104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052881Medicaid
NY052881Other0000000