Healthcare Provider Details

I. General information

NPI: 1487944575
Provider Name (Legal Business Name): NICOLETTE JOANNE BIDLINGMEYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 01/09/2024
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 W JEFFERSON BLVD STE 301
LOS ANGELES CA
90066-7032
US

IV. Provider business mailing address

21707 HAWTHORNE BLVD STE 300
TORRANCE CA
90503-7016
US

V. Phone/Fax

Practice location:
  • Phone: 424-443-5555
  • Fax:
Mailing address:
  • Phone: 323-737-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: