Provider Demographics
NPI:1164798898
Name:MONROE, KRISTINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 W 3RD ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4318
Mailing Address - Country:US
Mailing Address - Phone:323-546-7792
Mailing Address - Fax:
Practice Address - Street 1:8075 W 3RD ST
Practice Address - Street 2:SUITE 306
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4318
Practice Address - Country:US
Practice Address - Phone:323-546-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24929103T00000X
NY019303103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist