Provider Demographics
NPI: | 1134318223 |
---|---|
Name: | MONTESI, ALEXANDRA (PHD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALEXANDRA |
Middle Name: | |
Last Name: | MONTESI |
Suffix: | |
Gender: | F |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 8033 SUNSET BLVD. STE. 843 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90046-2401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 323-951-7050 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8033 SUNSET BLVD. |
Practice Address - Street 2: | SUITE 843 |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90046-2401 |
Practice Address - Country: | US |
Practice Address - Phone: | 323-951-7050 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-10-15 |
Last Update Date: | 2007-10-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PSY13573 | 103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TF0200X, 103TH0004X, 103TH0100X, 103TM1800X, 103TR0400X, 103TS0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health |
No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | PSY13573 | Medicaid | |
CA | PSY13573 | Medicaid |