Provider Demographics
NPI:1538439195
Name:KASUKABE LEE, NICOLE SACHI (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SACHI
Last Name:KASUKABE LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19431 RUE DE VALORE #2H
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2308
Mailing Address - Country:US
Mailing Address - Phone:626-489-4112
Mailing Address - Fax:
Practice Address - Street 1:19431 RUE DE VALORE #2H
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2308
Practice Address - Country:US
Practice Address - Phone:626-489-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW76124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker