Provider Demographics
NPI:1437228970
Name:VINCENT, NICOLE RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RENEE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:CHOC - DEPARTMENT OF PEDIATRIC PSYCHOLOGY
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-532-8483
Mailing Address - Fax:714-532-8756
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:CHOC - DEPARTMENT OF PEDIATRIC PSYCHOLOGY
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-532-8483
Practice Address - Fax:714-532-8756
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16341103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service