Provider Demographics
NPI:1639215916
Name:NOCERINO, DEMETRIUS JAMES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIUS
Middle Name:JAMES
Last Name:NOCERINO
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:SAN QUENTIN
Mailing Address - State:CA
Mailing Address - Zip Code:94964-0001
Mailing Address - Country:US
Mailing Address - Phone:925-434-2275
Mailing Address - Fax:
Practice Address - Street 1:2086 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4902
Practice Address - Country:US
Practice Address - Phone:925-260-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY25671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist