Provider Demographics
NPI:1720475825
Name:NEURO-REHAB CONSULTATION & TREATMENT SERVICES
Entity Type:Organization
Organization Name:NEURO-REHAB CONSULTATION & TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-710-7838
Mailing Address - Street 1:995 E GREEN ST
Mailing Address - Street 2:#422
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2410
Mailing Address - Country:US
Mailing Address - Phone:626-710-7838
Mailing Address - Fax:626-270-4234
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:#340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-710-7838
Practice Address - Fax:626-270-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty