Provider Demographics
NPI:1528243532
Name:CORTES ARDILLA, MONICA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:CORTES ARDILLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12099 W WASHINGTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2622
Mailing Address - Country:US
Mailing Address - Phone:310-437-7000
Mailing Address - Fax:310-313-7652
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2622
Practice Address - Country:US
Practice Address - Phone:310-437-7000
Practice Address - Fax:310-313-7652
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31653101YM0800X
CALCSW 764671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health