Provider Demographics
NPI:1003666942
Name:MITTAL, MONICA LILLIAN (MSC, MSW, PPSC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LILLIAN
Last Name:MITTAL
Suffix:
Gender:F
Credentials:MSC, MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GOLDEN SPAR PL
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2458
Mailing Address - Country:US
Mailing Address - Phone:310-291-4318
Mailing Address - Fax:
Practice Address - Street 1:3815 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3500
Practice Address - Country:US
Practice Address - Phone:310-291-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94512104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker