MEDICARE: MS. ERICA BREGE VON BLEICKEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	125103	CA

General Provider Information

NPI Number	:	1306679782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA BREGE VON BLEICKEN LCSW

Provider Business Mailing Address
First Line	:	2113 S RIDGELEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2023
Country	:	US
Telephone Number	:	718-736-3907
Fax Number	:

Provider Business Practice Location Address
First Line	:	2113 S RIDGELEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2023
Country	:	US
Telephone Number	:	718-736-3907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	05/23/2026

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