Provider Demographics
NPI:1306679782
Name:VON BLEICKEN, ERICA BREGE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:BREGE
Last Name:VON BLEICKEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BREGE
Other - Middle Name:
Other - Last Name:VON BLEICKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2113 S RIDGELEY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-2023
Mailing Address - Country:US
Mailing Address - Phone:718-736-3907
Mailing Address - Fax:
Practice Address - Street 1:2113 S RIDGELEY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-2023
Practice Address - Country:US
Practice Address - Phone:718-736-3907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1251031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical