Provider Demographics
NPI:1467045765
Name:ROCCA, NICOLE RENEE (LMFT, PPS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:ROCCA
Suffix:
Gender:F
Credentials:LMFT, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30423 CANWOOD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4314
Mailing Address - Country:US
Mailing Address - Phone:805-444-8377
Mailing Address - Fax:
Practice Address - Street 1:30423 CANWOOD ST STE 120
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4314
Practice Address - Country:US
Practice Address - Phone:805-444-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT45317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist