Provider Demographics
NPI:1700070836
Name:KADKHODA, MONICA FARASSAT (MA)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:FARASSAT
Last Name:KADKHODA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:FARASSAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3201 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2344
Mailing Address - Country:US
Mailing Address - Phone:310-453-7010
Mailing Address - Fax:310-829-7868
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:310-453-7010
Practice Address - Fax:310-829-7868
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist