Provider Demographics
NPI:1184902678
Name:RICH, MONA DOLORES (MFC 33762)
Entity type:Individual
Prefix:MS
First Name:MONA
Middle Name:DOLORES
Last Name:RICH
Suffix:
Gender:F
Credentials:MFC 33762
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 S WESTERN AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4326
Mailing Address - Country:US
Mailing Address - Phone:310-715-8885
Mailing Address - Fax:310-715-8889
Practice Address - Street 1:15508 S WESTERN AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4326
Practice Address - Country:US
Practice Address - Phone:310-715-8885
Practice Address - Fax:310-715-8889
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist