Provider Demographics
NPI:1912042847
Name:LODGEN-ROCKLIN, ERICA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:LODGEN-ROCKLIN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:LODGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LMFT
Mailing Address - Street 1:16530 VENTURA BLVD
Mailing Address - Street 2:#305
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4554
Mailing Address - Country:US
Mailing Address - Phone:818-414-5355
Mailing Address - Fax:
Practice Address - Street 1:21545 CENTRE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2947
Practice Address - Country:US
Practice Address - Phone:661-259-9439
Practice Address - Fax:661-259-9658
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist