Provider Demographics
NPI:1457133654
Name:BEARD, S NYCOLE (ACSW)
Entity Type:Individual
Prefix:MS
First Name:S NYCOLE
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 TRIMMER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-6310
Mailing Address - Country:US
Mailing Address - Phone:916-776-3001
Mailing Address - Fax:
Practice Address - Street 1:438 CAMINO DEL RIO S STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3546
Practice Address - Country:US
Practice Address - Phone:855-550-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1184041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical