Nicole Phyllis Bermensolo, MA
Psychologist, Group Psychotherapy in Los Angeles, CA. Individual provider (NPI-1).
NPI number1700525607
StatusActive
Last updated in NPPESOct 9, 2022
Details
- NPI
- 1700525607
- Entity type
- Individual (NPI-1)
- Name
- Nicole Phyllis Bermensolo
- Credential
- MA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 31, 2022
- Certification date
- Oct 9, 2022
- Last updated
- Oct 9, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TP2701X | Psychologist, Group Psychotherapy | 132721 | CA | Yes |
Practice location
10586 W Pico Blvd # 257Los Angeles, CA 90064-2332
Phone 424-271-5221
Mailing address
10586 W Pico Blvd # 257Los Angeles, CA 90064-2332
Phone 424-271-5221
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