Provider Demographics
NPI:1871368175
Name:COFFMAN KEENEY, MONICA PAIGE (LCSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:PAIGE
Last Name:COFFMAN KEENEY
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 1:228 WINDSOR RIVER RD STE 510
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9206
Mailing Address - Country:US
Mailing Address - Phone:707-387-1965
Mailing Address - Fax:
Practice Address - Street 1:1202 APOLLO WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6777
Practice Address - Country:US
Practice Address - Phone:707-565-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1112231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical