Provider Demographics
NPI:1326082165
Name:RANSON, NICOLA M L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLA
Middle Name:M L
Last Name:RANSON
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 1:174 ANDREW AVE
Mailing Address - Street 2:
Mailing Address - City:LEUCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1101
Mailing Address - Country:US
Mailing Address - Phone:760-753-2604
Mailing Address - Fax:760-632-6859
Practice Address - Street 1:2210 ENCINITAS BLVD STE T
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-753-2604
Practice Address - Fax:760-632-6859
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS184691041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43610059200Medicare ID - Type UnspecifiedENROLLMENT REFERENCE
SW18469AMedicare PIN