Provider Demographics
NPI:1770619819
Name:SOCHACZEWSKI, ALISE YVETTE (MFT)
Entity type:Individual
Prefix:
First Name:ALISE
Middle Name:YVETTE
Last Name:SOCHACZEWSKI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 WILSHIRE BLVD
Mailing Address - Street 2:#317
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4218
Mailing Address - Country:US
Mailing Address - Phone:310-717-4924
Mailing Address - Fax:
Practice Address - Street 1:914 S ROBERTSON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1639
Practice Address - Country:US
Practice Address - Phone:310-717-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist