Provider Demographics
NPI:1326140898
Name:MONROE, TREVOR LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:LOUIS
Last Name:MONROE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3112
Mailing Address - Country:US
Mailing Address - Phone:562-728-4565
Mailing Address - Fax:562-728-4565
Practice Address - Street 1:4401 ATLANTIC AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2218
Practice Address - Country:US
Practice Address - Phone:562-728-4565
Practice Address - Fax:562-728-4565
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16406103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY164060Medicaid
CACP16406Medicare ID - Type Unspecified