Provider Demographics
NPI:1114049657
Name:NICELY, ERIC SHAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SHAWN
Last Name:NICELY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:STE 1019
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3402
Mailing Address - Country:US
Mailing Address - Phone:415-955-1975
Mailing Address - Fax:415-901-0675
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:STE 1019
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-955-1975
Practice Address - Fax:415-901-0675
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical