Provider Demographics
NPI:1518342690
Name:GREEN, MONICA (PHD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:STUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:633 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3246
Mailing Address - Country:US
Mailing Address - Phone:661-208-1633
Mailing Address - Fax:
Practice Address - Street 1:385 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1040
Practice Address - Country:US
Practice Address - Phone:714-681-9070
Practice Address - Fax:714-773-4788
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical