Provider Demographics
NPI:1275822959
Name:NEFDT-GONZALEZ, NICOLETTE (PHD)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:NEFDT-GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 COCHRAN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1925
Mailing Address - Country:US
Mailing Address - Phone:805-583-8060
Mailing Address - Fax:805-583-8064
Practice Address - Street 1:685 COCHRAN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1925
Practice Address - Country:US
Practice Address - Phone:805-583-8060
Practice Address - Fax:805-583-8064
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-08-4616103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst