1194787903 NPI number — MS. MARTHA ELIZABETH MONAGHAN MSW LCSW C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194787903 NPI number — MS. MARTHA ELIZABETH MONAGHAN MSW LCSW C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MONAGHAN

Provider First Name:

MARTHA

Provider Middle Name:

ELIZABETH

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

MSW LCSW C

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1194787903

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/20/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

30 GREENWAY NW

Provider Second Line Business Mailing Address:

SUITE 5

Provider Business Mailing Address City Name:

GLEN BURNIE

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21061-3557

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-760-9079

Provider Business Mailing Address Fax Number:

410-760-1121

Provider First Line Business Practice Location Address:

30 GREENWAY ST NW STE 5

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GLEN BURNIE

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21061-3557

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-760-9079

Provider Business Practice Location Address Fax Number:

410-760-1121

Provider Enumeration Date:

04/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  06961 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 10422720 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
• Identifier: 52674007 . This is a "BS OF MD" identifier . This identifiers is of the category "OTHER".
• Identifier: 001508 . This is a "VALUE OPTIONS AND GREAT W" identifier . This identifiers is of the category "OTHER".
• Identifier: S003 . This is a "BLUE SHIELD FEDERAL GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 0004 . This is a "BLUE SHIELD FEDERAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 164652 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
• Identifier: 5751523 . This is a "AETNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 513268 . This is a "NCPPO INNOVA MHIP" identifier . This identifiers is of the category "OTHER".
• Identifier: 52674007 . This is a "BLUE SHIELD OF MD" identifier . This identifiers is of the category "OTHER".
• Identifier: 048056000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".
• Identifier: 100024224 . This is a "APS" identifier . This identifiers is of the category "OTHER".
• Identifier: 164652 . This is a "MHN AND TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 345450 . This is a "MAMSI UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".