Provider Demographics
NPI:1508405416
Name:LODATO, NICK (MA,AMFT)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:LODATO
Suffix:
Gender:M
Credentials:MA,AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 N OGDEN DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-1727
Mailing Address - Country:US
Mailing Address - Phone:310-904-8216
Mailing Address - Fax:
Practice Address - Street 1:321 N LARCHMONT BLVD STE 506
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6405
Practice Address - Country:US
Practice Address - Phone:310-904-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist