Provider Demographics
NPI:1386762607
Name:FREDERICK, MONICA MICHIELS (PSYD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:MICHIELS
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:PSYD
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Mailing Address - Street 1:11201 BENTON ST
Mailing Address - Street 2:116 (A)
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357-1000
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-777-3226
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:116 (A)
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3226
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY22313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY22313OtherCALIFORNIA BOARD OF PSYCHOLOGY