Active NPI
Eric Shawn Nicely, PSYD
- Clinical Psychologist
- San Francisco, CA
National Provider Identifier
1114049657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18892
- Practice address
- 220 Montgomery St
Ste 1019
San Francisco, CA 94104-3402 - Phone
- (415) 955-1975
- Fax
- (415) 901-0675
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18892 | CA | Primary |
Addresses
Primary practice location
220 Montgomery St
Ste 1019
San Francisco, CA 94104-3402
Mailing address
220 Montgomery St
Ste 1019
San Francisco, CA 94104-3402
Phone (415) 955-1975
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18892 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266451200000",
"number": "1114049657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 MONTGOMERY ST",
"address_2": "STE 1019",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941043402",
"telephone_number": "415-955-1975",
"fax_number": "415-901-0675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 MONTGOMERY ST",
"address_2": "STE 1019",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941043402",
"telephone_number": "415-955-1975",
"fax_number": "415-901-0675"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICELY",
"first_name": "ERIC",
"middle_name": "SHAWN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2010-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.