Provider Demographics
NPI:1184749889
Name:MEYER, ERICA MONDRO (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MONDRO
Last Name:MEYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1902 SHELL AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3879
Mailing Address - Country:US
Mailing Address - Phone:310-948-0734
Mailing Address - Fax:310-285-5068
Practice Address - Street 1:1112 OCEAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5448
Practice Address - Country:US
Practice Address - Phone:310-948-0734
Practice Address - Fax:310-285-5068
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20215103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist