Provider Demographics
NPI:1871624734
Name:MON, NANCI LEE (LISW)
Entity type:Individual
Prefix:MS
First Name:NANCI
Middle Name:LEE
Last Name:MON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9917
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-5917
Mailing Address - Country:US
Mailing Address - Phone:505-982-3812
Mailing Address - Fax:
Practice Address - Street 1:1300 CAMINO SIERRA VISTA
Practice Address - Street 2:BF YOUNG PROFESSIONAL BLDG.
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-467-2503
Practice Address - Fax:505-989-5568
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-01261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98373Medicaid