NPIMap

Organization Active NPI

Beach Psychotherapy

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1104051804
Registry record updated May 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BEACH PSYCHOTHERAPY
Practice address
1767 Grand Ave Ste 4
San Diego, CA 92109-4400
Phone
(877) 293-8123
Fax
(858) 273-9410
NPI assigned
May 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2009

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

Authorized official

Name
Nicole Dockter, LCSWNPI 1518090687
Title
Co-Director
Phone
(619) 318-5012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

1767 Grand Ave Ste 4
San Diego, CA 92109-4400

Mailing address

1767 Grand Ave Ste 4
San Diego, CA 92109-4400
Phone (877) 293-8123

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1104051804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1767 GRAND AVE STE 4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921094400",
            "telephone_number": "877-293-8123",
            "fax_number": "858-273-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1767 GRAND AVE STE 4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921094400",
            "telephone_number": "877-293-8123",
            "fax_number": "858-273-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH PSYCHOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-26",
        "last_updated": "2009-05-26",
        "status": "A",
        "authorized_official_last_name": "DOCKTER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CO-DIRECTOR",
        "authorized_official_telephone_number": "619-318-5012",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; 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.