MEDICARE: MONICA BEZZI DEMAS LMFT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106H00000X	Marriage & Family Therapist	LMFT77371	CA

General Provider Information

NPI Number	:	1902082803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA BEZZI DEMAS LMFT

Provider Business Mailing Address
First Line	:	624 W 9TH ST
Second Line	:	SUITE 204
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-3158
Country	:	US
Telephone Number	:	310-938-4575
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 W 9TH ST
Second Line	:	SUITE 204
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-3158
Country	:	US
Telephone Number	:	310-938-4575
Fax Number	:

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

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	11/25/2013

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