Brenda Nickolaison, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

40809 Issued in TX

Practice address

4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680

Phone

(800) 257-8715

Fax

(800) 819-1655

NPI assigned

Sep 5, 2006

Last updated

Mar 3, 2010By the provider in NPPES

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• .Sunstar Geriatrics Healthcare PA

  • Geriatric Medicine (Internal Medicine) Physician
  • Georgetown, TX
  • NPI 1033151428
  NPD (past)

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267574400000",
    "number": "1679675961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12608 CAMPANA DR",
            "city": "DEL VALLE",
            "state": "TX",
            "postal_code": "786173621",
            "telephone_number": "402-730-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 VIEWRIDGE AVE STE 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231680",
            "telephone_number": "800-257-8715",
            "fax_number": "800-819-1655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKOLAISON",
        "first_name": "BRENDA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-05",
        "last_updated": "2010-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "40809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Walter Nickerson, M.D.
• Heather Nickerson, MA, RBT
• Wendy Diane Nickerson, LCSW
• Aikkiko Nickler, IDC
• Carol Cristman Nickless, RN, PHN, BSN
• Juliet Nicodemus
• Janet Cochran Nicol, RN
• Francis Michael Nicola, IDC
• Adelle Nicolas, FNP
• Dalia Nicolas

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.

Verify at the official NPI Registry.