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NPI Code Detail

MEDICARE: NICOLE GERSHENSON

MEDICARE: NICOLE GERSHENSON
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
1106H00000XMarriage & Family Therapist99854CA
2106H00000XMarriage & Family Therapist87550CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1#95-2633765OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1568823102
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GERSHENSON
Provider Business Mailing Address
First Line : 5535 BALBOA BLVD STE 202
Second Line :
City : ENCINO
State : CA
Zip : 91316-1541
Country : US
Telephone Number : 818-401-8889
Fax Number : 818-330-4206
Provider Business Practice Location Address
First Line : 5535 BALBOA BLVD STE 202
Second Line :
City : ENCINO
State : CA
Zip : 91316-1541
Country : US
Telephone Number : 818-401-8889
Fax Number : 818-330-4206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2016
Last Update Date : 02/20/2020

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Directions to “ NICOLE GERSHENSON ” Practice Location

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