Provider Demographics
NPI:1609942846
Name:NASSEN, NIKOLE N (PHD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLE
Middle Name:N
Last Name:NASSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 4TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3172
Mailing Address - Country:US
Mailing Address - Phone:619-231-2668
Mailing Address - Fax:
Practice Address - Street 1:614 5TH AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6964
Practice Address - Country:US
Practice Address - Phone:619-231-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical