Provider Demographics
NPI:1841843331
Name:GUZOFSKY, NICOLE LEAH (MA, MFT #118457)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEAH
Last Name:GUZOFSKY
Suffix:
Gender:F
Credentials:MA, MFT #118457
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILSHIRE BLVD APT 2102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1950
Mailing Address - Country:US
Mailing Address - Phone:480-861-9633
Mailing Address - Fax:
Practice Address - Street 1:617 S OLIVE ST STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1646
Practice Address - Country:US
Practice Address - Phone:480-861-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty