MEDICARE: ALISE YVETTE SOCHACZEWSKI M.F.T.

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	106H00000X	Marriage & Family Therapist	MFC 39873	CA

General Provider Information

NPI Number	:	1770619819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISE YVETTE SOCHACZEWSKI M.F.T.

Provider Business Mailing Address
First Line	:	5482 WILSHIRE BLVD
Second Line	:	#317
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4218
Country	:	US
Telephone Number	:	310-717-4924
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 S ROBERTSON BLVD
Second Line	:	SUITE 105
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1639
Country	:	US
Telephone Number	:	310-717-4924
Fax Number	:

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

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	07/19/2007

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