Healthcare Provider Details

I. General information

NPI: 1922184803
Provider Name (Legal Business Name): MONICA BENITEZ KELSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 WESTWOOD BLVD. #101
LOS ANGELES CA
90024
US

IV. Provider business mailing address

P.O. BOX 491231
LOS ANGELES CA
90049
US

V. Phone/Fax

Practice location:
  • Phone: 310-629-2974
  • Fax: 310-440-0318
Mailing address:
  • Phone: 310-629-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13224
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: