Active NPI
Camille Nichols, MFT
- Marriage & Family Therapist
- Berkeley, CA
National Provider Identifier
1073657656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT35621
- Practice address
- 1314 Cornell Ave
Berkeley, CA 94702-1010 - Phone
- (510) 526-3292
- Fax
- (510) 526-3755
- NPI assigned
- Feb 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT35621 | CA | Primary |
Addresses
Primary practice location
1314 Cornell Ave
Berkeley, CA 94702-1010
Mailing address
1314 Cornell Ave
Berkeley, CA 94702-1010
Phone (510) 526-3292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 4, 2024 through Jan 4, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT35621 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073657656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1314 CORNELL AVE",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947021010",
"telephone_number": "510-526-3292",
"fax_number": "510-526-3755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1314 CORNELL AVE",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947021010",
"telephone_number": "510-526-3292",
"fax_number": "510-526-3755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "CAMILLE",
"name_prefix": "Ms.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFT35621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.