Provider Demographics
NPI:1649559584
Name:MICHAELI, NICOLE (PHD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MICHAELI
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 1:16001 VENTURA BLVD
Mailing Address - Street 2:# 125
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4481
Mailing Address - Country:US
Mailing Address - Phone:818-789-5035
Mailing Address - Fax:
Practice Address - Street 1:16001 VENTURA BLVD
Practice Address - Street 2:# 125
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4481
Practice Address - Country:US
Practice Address - Phone:818-789-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical