Provider Demographics
NPI:1356730683
Name:SIERACKI, NICHOLE (PHD)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:SIERACKI
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 1:6711 S NEW BRAUNFELS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3002
Mailing Address - Country:US
Mailing Address - Phone:210-531-7870
Mailing Address - Fax:210-531-7478
Practice Address - Street 1:6711 S NEW BRAUNFELS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3002
Practice Address - Country:US
Practice Address - Phone:210-531-7870
Practice Address - Fax:210-531-7478
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical