Provider Demographics
NPI:1881471167
Name:NINO, CECILIA A (PSYD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:A
Last Name:NINO
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 GREENVILLE AVE STE 1050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4084
Mailing Address - Country:US
Mailing Address - Phone:214-918-1999
Mailing Address - Fax:
Practice Address - Street 1:4925 GREENVILLE AVE STE 1050
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4084
Practice Address - Country:US
Practice Address - Phone:214-918-1999
Practice Address - Fax:972-850-9452
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical