Provider Demographics
NPI:1811423742
Name:NICOLAOU, TERESA ROXANNE (LMFT, PSYD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ROXANNE
Last Name:NICOLAOU
Suffix:
Gender:F
Credentials:LMFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2407
Mailing Address - Country:US
Mailing Address - Phone:213-308-0505
Mailing Address - Fax:
Practice Address - Street 1:241 19TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2407
Practice Address - Country:US
Practice Address - Phone:213-308-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT99236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist