Provider Demographics
NPI:1194518266
Name:KRISTIN ELIZABETH MONACO LLC
Entity type:Organization
Organization Name:KRISTIN ELIZABETH MONACO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:LAMFT
Authorized Official - Phone:610-200-8119
Mailing Address - Street 1:2541 FAIRHILL AVE REAR
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3115
Mailing Address - Country:US
Mailing Address - Phone:610-200-8119
Mailing Address - Fax:
Practice Address - Street 1:520 CARPENTER LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-3453
Practice Address - Country:US
Practice Address - Phone:610-200-8119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center