Provider Demographics
NPI:1750770756
Name:GRIFFIN-GAY, MONIQUE (MED, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:
Last Name:GRIFFIN-GAY
Suffix:
Gender:F
Credentials:MED, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 SOUTHERN OAK LOOP
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-1004
Mailing Address - Country:US
Mailing Address - Phone:305-360-7943
Mailing Address - Fax:
Practice Address - Street 1:1916 SOUTHERN OAK LOOP
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-1004
Practice Address - Country:US
Practice Address - Phone:305-360-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW120241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical