Provider Demographics
NPI:1831211838
Name:JAIMES, MONICA MARIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MARIE
Last Name:JAIMES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 CABALLO AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:323-610-3460
Mailing Address - Fax:
Practice Address - Street 1:14600 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3363
Practice Address - Country:US
Practice Address - Phone:626-337-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF67509101YM0800X
CAIMF101145106H00000X
CALMFT109539106H00000X
CAIMF48140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007302Medicaid
CACBSC864OtherLA DMH PROVIDER