Provider Demographics
NPI:1467864173
Name:ALBERTS, NICOLE MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARY
Last Name:ALBERTS
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 1:262 DANNY THOMAS PLACE, MAIL STOP 740
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY, ST JUDE CHILDREN'S RESEARCH H
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105
Mailing Address - Country:US
Mailing Address - Phone:901-595-7650
Mailing Address - Fax:901-595-4701
Practice Address - Street 1:262 DANNY THOMAS PLACE, MAIL STOP 740
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY, ST JUDE CHILDREN'S RESEARCH H
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-595-7650
Practice Address - Fax:901-595-4701
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2017-05-17
Deactivation Date:2015-01-07
Deactivation Code:
Reactivation Date:2017-03-30
Provider Licenses
StateLicense IDTaxonomies
TN3441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist