Provider Demographics
NPI:1588862536
Name:MIKAEL, MONA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:MIKAEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2021
Mailing Address - Country:US
Mailing Address - Phone:626-710-7838
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 307
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2021
Practice Address - Country:US
Practice Address - Phone:626-710-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019390103G00000X
CA5089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist