Kathleen Anne Nickerson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY20446 Issued in CA

Practice address

280 Newport Center Dr
Suite 200
Newport Beach, CA 92660-7526

Phone

(949) 222-6688

Fax

(949) 716-7885

NPI assigned

Feb 7, 2007

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

Doctor of Philosophy

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.

• Coastal Counseling & Coaching, Inc

  • Community/Behavioral Health Agency
  • Newport Beach, CA
  • NPI 1437322237
  NPD (past) Authorized official

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1639219694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 NEWPORT CENTER DR",
            "address_2": "SUITE 200",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607526",
            "telephone_number": "949-222-6688",
            "fax_number": "949-716-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 NEWPORT CENTER DR",
            "address_2": "SUITE 200",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607526",
            "telephone_number": "949-222-6688",
            "fax_number": "949-716-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "KATHLEEN",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Nicasio
• Michael Wayne Niccole, M.D.
• Nicholas C. Davis, D.D.S., Apc
• Nicholas E. Rose, MD, Inc.
• Chelsie Nicholson
• Nickul S. Jain MD, a Professional Corporation
• Odile Nicolette, LMFT
• Gregg Nielson, RVT
• Cecilia Nieto
• Nisa Nikbakht

• Clinical Psychologist in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.