Provider Demographics
NPI:1861844102
Name:REINOSA, NICOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:REINOSA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 HANOVER AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5605
Mailing Address - Country:US
Mailing Address - Phone:925-391-0552
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE # 6B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-5270
Practice Address - Fax:415-206-4722
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247000000X, 390200000X
CAPSY33894103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program