Provider Demographics
NPI:1023025848
Name:MONE, LOU (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:LOU
Middle Name:
Last Name:MONE
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3343
Mailing Address - Country:US
Mailing Address - Phone:619-575-1541
Mailing Address - Fax:619-575-1541
Practice Address - Street 1:2850 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6208
Practice Address - Country:US
Practice Address - Phone:619-575-1541
Practice Address - Fax:619-575-1541
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 22441041C0700X
CAMFT 5829106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW022440Medicaid
CACSW022440Medicaid