Provider Demographics
NPI:1447371992
Name:WHALEN, MONICA KATHLEEN (LMSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:KATHLEEN
Last Name:WHALEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4C SALMON RUN
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1484
Mailing Address - Country:US
Mailing Address - Phone:585-392-1169
Mailing Address - Fax:
Practice Address - Street 1:150 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1238
Practice Address - Country:US
Practice Address - Phone:315-331-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064562104100000X
NY0768411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker