Provider Demographics
NPI:1528479300
Name:ROBERTSON, MONIQUE NICOL (LMFT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NICOL
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:NICOL
Other - Last Name:DE SANTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 OCEANGATE FL 12
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4312
Mailing Address - Country:US
Mailing Address - Phone:323-457-6896
Mailing Address - Fax:
Practice Address - Street 1:100 OCEANGATE FL 12
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4312
Practice Address - Country:US
Practice Address - Phone:323-457-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121097106H00000X, 106H00000X
CAMFT INTERN # 94097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist