Provider Demographics
NPI:1922184803
Name:KELSON, MONICA BENITEZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:BENITEZ
Last Name:KELSON
Suffix:
Gender:F
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:P.O. BOX 491231
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-629-2974
Mailing Address - Fax:
Practice Address - Street 1:1314 WESTWOOD BLVD.
Practice Address - Street 2:#101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-629-2974
Practice Address - Fax:310-440-0318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13224103TC0700X, 103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY13224OtherPSYCHOLOGIST