Provider Demographics
NPI:1942337464
Name:READE- SAN JOSE, MONICA ANN (LMFT 91212)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ANN
Last Name:READE- SAN JOSE
Suffix:
Gender:F
Credentials:LMFT 91212
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 KATELLA AVE STE 380
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3399
Mailing Address - Country:US
Mailing Address - Phone:562-280-2017
Mailing Address - Fax:562-597-5692
Practice Address - Street 1:3851 KATELLA AVE STE 380
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3399
Practice Address - Country:US
Practice Address - Phone:562-280-2017
Practice Address - Fax:562-597-5692
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA91212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225400000XOtherREHABILITATION PRACTITION