Provider Demographics
NPI: | 1023149861 |
---|---|
Name: | CHOCRON, LUCIEN (DR, LMFT, PSYD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | LUCIEN |
Middle Name: | |
Last Name: | CHOCRON |
Suffix: | |
Gender: | M |
Credentials: | DR, LMFT, PSYD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 14416 HAMLIN ST |
Mailing Address - Street 2: | SUITE 102 |
Mailing Address - City: | VAN NUYS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91401-1486 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-822-6550 |
Mailing Address - Fax: | 310-273-1818 |
Practice Address - Street 1: | 14416 HAMLIN ST |
Practice Address - Street 2: | SUITE 102 |
Practice Address - City: | VAN NUYS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91401-1486 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-361-5030 |
Practice Address - Fax: | 818-365-7707 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-03-07 |
Last Update Date: | 2014-01-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PBS32170 | 101YM0800X |
CA | MFC50440 | 103T00000X, 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |