Elizabeth L. Nickels, M.A., PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY22119 Issued in CA

Practice address

400 Estudillo Ave Ste 100
San Leandro, CA 94577-4962

Phone

(510) 746-1188

NPI assigned

May 30, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Agesong Emeryville Owner, LLC

  • Assisted Living Facility
  • Emeryville, CA
  • NPI 1245568815
  NPD (past)
• Watermark Bayside, LLC

  • Assisted Living Facility
  • Emeryville, CA
  • NPI 1174980338
  NPD (past)

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1184882607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2662 WALLACE ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946063346",
            "telephone_number": "510-414-2416",
            "fax_number": "510-250-6923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ESTUDILLO AVE STE 100",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774962",
            "telephone_number": "510-746-1188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1440 40th St",
            "address_purpose": "LOCATION",
            "city": "Emeryville",
            "state": "CA",
            "postal_code": "946083552",
            "country_code": "US",
            "telephone_number": "510-594-8800 x357",
            "fax_number": "510-250-6923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKELS",
        "first_name": "ELIZABETH",
        "middle_name": "L.",
        "credential": "M.A., PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-30",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivian Vy Doan Nguyen, OTR
• Michael Anthony Niaki, M.D.
• Jeanine Nicholas
• Bri-Anna Elice Nicholson
• Timothy Mark Nickell, MHRS
• Kalene Nickelson, ASW
• Joshua Niclas, M.D.
• Brittany Nielsen
• Berenice Alejandrina Nieto, IBCLC
• Pamela Nieto

• Clinical Psychologist in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.