Healthcare Provider Details

I. General information

NPI: 1528479300
Provider Name (Legal Business Name): MONIQUE NICOL ROBERTSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIQUE NICOL DE SANTIS

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

IV. Provider business mailing address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-9392
  • Fax:
Mailing address:
  • Phone: 562-981-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT121097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: