Provider Demographics
NPI:1528826195
Name:DUQUE, MONICA (LCAT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DUQUE
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1335
Mailing Address - Country:US
Mailing Address - Phone:732-852-7373
Mailing Address - Fax:
Practice Address - Street 1:1049 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1335
Practice Address - Country:US
Practice Address - Phone:732-852-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00011800221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist