Provider Demographics
NPI:1033368139
Name:STOCKBERGER, NICOLA (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:NICOLA
Middle Name:
Last Name:STOCKBERGER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 PALOS VERDES DR N
Mailing Address - Street 2:218
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3724
Mailing Address - Country:US
Mailing Address - Phone:310-325-3873
Mailing Address - Fax:310-325-9302
Practice Address - Street 1:2075 PALOS VERDES DR N
Practice Address - Street 2:218
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3724
Practice Address - Country:US
Practice Address - Phone:310-325-3873
Practice Address - Fax:310-325-9302
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist