Provider Demographics
NPI:1982130514
Name:NIPOMNICK, SUMMER (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:
Last Name:NIPOMNICK
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 1:200 TAMAL PLAZA, SUITE 235
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925
Mailing Address - Country:US
Mailing Address - Phone:415-755-3456
Mailing Address - Fax:415-432-7088
Practice Address - Street 1:200 TAMAL PLAZA, SUITE 235
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925
Practice Address - Country:US
Practice Address - Phone:415-755-3456
Practice Address - Fax:415-432-7088
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24956103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical