Nina Clark Ericson, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY12589 Issued in CA

Practice address

1220 University Dr Ste 103
Menlo Park, CA 94025-4265

Phone

(650) 533-3130

NPI assigned

Jun 17, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1649830282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 BRYANT ST",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943012712",
            "telephone_number": "650-533-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 UNIVERSITY DR STE 103",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254265",
            "telephone_number": "650-533-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICSON",
        "first_name": "NINA",
        "middle_name": "CLARK",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY12589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.ninaclarkericson.com",
            "affiliation": "N",
            "endpointDescription": "Business Website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Business Website",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Practice Information",
            "address_1": "1220 University Dr Ste 103",
            "city": "Menlo Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940254265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychologist in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; 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.