Provider Demographics
NPI:1568694289
Name:BOCKARIE, PHILIP MICHAEL
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:BOCKARIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:MICHAEL
Other - Last Name:BOCKARIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH
Mailing Address - Street 1:3211 WEST IMPERIAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303
Mailing Address - Country:US
Mailing Address - Phone:310-419-9616
Mailing Address - Fax:310-590-1357
Practice Address - Street 1:3211 WEST IMPERIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303
Practice Address - Country:US
Practice Address - Phone:310-419-9616
Practice Address - Fax:310-590-1357
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional