Provider Demographics
NPI:1508337288
Name:VON HEIDEGGER, NICOLETTA ERIN PAULINA (MA, MED,LMFT #110256)
Entity Type:Individual
Prefix:MS
First Name:NICOLETTA
Middle Name:ERIN PAULINA
Last Name:VON HEIDEGGER
Suffix:
Gender:F
Credentials:MA, MED,LMFT #110256
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19901 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1822
Mailing Address - Country:US
Mailing Address - Phone:818-399-7017
Mailing Address - Fax:
Practice Address - Street 1:9889 HELEN AVE
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1354
Practice Address - Country:US
Practice Address - Phone:323-486-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health