Basic Information
Provider Information
NPI: 1770536351
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONKS
FirstName: GENEVIEVE
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 9TH ST
Address2: ROOM 205 MAILSTOP 2-3
City: SACRAMENTO
State: CA
PostalCode: 958146414
CountryCode: US
TelephoneNumber: 9166542431
FaxNumber: 9166543186
Practice Location
Address1: 2100 NAPA-VALLEJO HIGHWAY
Address2:  
City: NAPA
State: CA
PostalCode: 945586293
CountryCode: US
TelephoneNumber: 7072535000
FaxNumber: 7072535513
Other Information
ProviderEnumerationDate: 05/18/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPSY16223CAX Behavioral Health & Social Service ProvidersPsychologistClinical
103TF0200XPSY16223CAX Behavioral Health & Social Service ProvidersPsychologistForensic

No ID Information.


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