MEDICARE: DR. LOUIS MONACO PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	16252	NY
2	103TC2200X	Clinical Child & Adolescent Psychologist	16252	NY
3	103TF0200X	Forensic Psychologist	16252	NY
4	103T00000X	Psychologist	16252	NY
5	103TC0700X	Clinical Psychologist	PSY 21425	CA
6	103TF0200X	Forensic Psychologist	PSY 21425	CA

General Provider Information

NPI Number	:	1578557062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS MONACO PSY.D.

Provider Business Mailing Address
First Line	:	9171 WILSHIRE BLVD
Second Line	:	#600
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5530
Country	:	US
Telephone Number	:	310-666-7952
Fax Number	:

Provider Business Practice Location Address
First Line	:	9171 WILSHIRE BLVD
Second Line	:	#600
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5530
Country	:	US
Telephone Number	:	310-666-7952
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	10/12/2007

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