Provider Demographics
NPI:1043467962
Name:MAKOWKA, NICOLE SIMONE (MA,, MFT INTERN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SIMONE
Last Name:MAKOWKA
Suffix:
Gender:F
Credentials:MA,, MFT INTERN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:SIMONE
Other - Last Name:ZAYKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,, MFT INTERN
Mailing Address - Street 1:13130 BURBANK BLVD.
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:818-947-5562
Mailing Address - Fax:818-988-2392
Practice Address - Street 1:13130 BURBANK BLVD.
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401
Practice Address - Country:US
Practice Address - Phone:818-947-5562
Practice Address - Fax:818-988-2392
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 57217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health