Provider Demographics
NPI:1346364759
Name:DITTRICH, MONICA R (MFT)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:R
Last Name:DITTRICH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:R
Other - Last Name:DITTRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:20812 4TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5846
Mailing Address - Country:US
Mailing Address - Phone:408-317-8440
Mailing Address - Fax:408-259-0865
Practice Address - Street 1:1650 LAS PLUMAS AVE STE K
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1657
Practice Address - Country:US
Practice Address - Phone:408-272-6735
Practice Address - Fax:408-259-0865
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist