Provider Demographics
NPI:1902039555
Name:DUARTE, NICHOLE ANTOINETTE (PHD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ANTOINETTE
Last Name:DUARTE
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 1:2204 S EL CAMINO REAL
Mailing Address - Street 2:STE 305
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6306
Mailing Address - Country:US
Mailing Address - Phone:858-869-9530
Mailing Address - Fax:858-524-3011
Practice Address - Street 1:2382 FARADAY AVE STE 250-12
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7218
Practice Address - Country:US
Practice Address - Phone:858-869-9530
Practice Address - Fax:858-524-3011
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical