Provider Demographics
NPI:1710135892
Name:LOEBACH, NICOLE (LCSW, MPH)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:LOEBACH
Suffix:
Gender:
Credentials:LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N MAR VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1411
Mailing Address - Country:US
Mailing Address - Phone:510-255-0965
Mailing Address - Fax:888-425-0567
Practice Address - Street 1:230 N MAR VISTA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1411
Practice Address - Country:US
Practice Address - Phone:510-255-0965
Practice Address - Fax:888-425-0567
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical