Molly Beth Nickerson, MSW, ACSW

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

923 S Catalina Ave
Redondo Beach, CA 90277-4718

Phone

(310) 792-5454

Fax

(310) 792-5463

NPI assigned

Sep 9, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Molly Beth Nickerson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1053560573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S PROSPECT AVE",
            "address_2": "UNIT 306",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902774456",
            "telephone_number": "310-793-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 S CATALINA AVE",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902774718",
            "telephone_number": "310-792-5454",
            "fax_number": "310-792-5463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "MOLLY",
        "middle_name": "BETH",
        "name_prefix": "Ms.",
        "credential": "MSW, ACSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053560573",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOLLY",
            "last_name": "NICKERSON",
            "middle_name": "BETH",
            "prefix": "MS.",
            "credential": "MSW, ACSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Rehabilitation Practitioner in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.