Provider Demographics
NPI:1033252283
Name:NIERODZIK, MISOOK OH (PSY D)
Entity Type:Individual
Prefix:MS
First Name:MISOOK
Middle Name:OH
Last Name:NIERODZIK
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N GRAND AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1757
Mailing Address - Country:US
Mailing Address - Phone:626-915-2110
Mailing Address - Fax:
Practice Address - Street 1:150 N GRAND AVE STE 212
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1757
Practice Address - Country:US
Practice Address - Phone:626-915-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43621106H00000X
225C00000X
CAPSY32024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor