Provider Demographics
NPI:1497130058
Name:HENNON, MONICA (PSYD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:HENNON
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 1:101 N INDIAN HILL BLVD
Mailing Address - Street 2:#C1-200
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4666
Mailing Address - Country:US
Mailing Address - Phone:909-333-7434
Mailing Address - Fax:
Practice Address - Street 1:101 N INDIAN HILL BLVD
Practice Address - Street 2:#C1-200
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4666
Practice Address - Country:US
Practice Address - Phone:909-333-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-26950103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist