Provider Demographics
NPI:1255766432
Name:NICHOLSON, ABBY BREITMAN (AMFT)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:BREITMAN
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MS
Other - First Name:ABBY
Other - Middle Name:RAE
Other - Last Name:BREITMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:PO BOX 641841
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-295-2248
Mailing Address - Fax:
Practice Address - Street 1:480 MANOR PLAZA
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044
Practice Address - Country:US
Practice Address - Phone:415-295-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health