Provider Demographics
NPI:1841500980
Name:DOWNEY, NICOLE ELYSE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELYSE
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 MOORPARK ST
Mailing Address - Street 2:200
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1260
Mailing Address - Country:US
Mailing Address - Phone:818-378-1165
Mailing Address - Fax:
Practice Address - Street 1:18226 VENTURA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4236
Practice Address - Country:US
Practice Address - Phone:818-378-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23532103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily