Provider Demographics
NPI:1518090687
Name:DOCKTER, NICOLE CARDOZA (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CARDOZA
Last Name:DOCKTER
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 1:1627 29TH ST #1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1419
Mailing Address - Country:US
Mailing Address - Phone:619-318-5012
Mailing Address - Fax:858-273-9410
Practice Address - Street 1:1767 GRAND AVE #4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109
Practice Address - Country:US
Practice Address - Phone:619-318-5012
Practice Address - Fax:858-273-9410
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22125OtherLICENSE #