Active NPI
Susan Nickerson
- Marriage & Family Therapist
- Camarillo, CA
National Provider Identifier
1720382633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 4749
- Practice address
- 1756 S Lewis Rd
Camarillo, CA 93012-8520 - Phone
- (805) 383-3669
- NPI assigned
- Jan 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CA | ||
| Marriage & Family Therapist | 106H00000X | 4749 | CA | Primary |
Addresses
Primary practice location
1756 S Lewis Rd
Camarillo, CA 93012-8520
Mailing address
10990 Del Norte St Apt 10
Ventura, CA 93004-1084
Phone (805) 383-3669
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 174400000X | Other | CA | REHAB ACTIVITY LEADER |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629676800000",
"number": "1720382633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10990 DEL NORTE ST APT 10",
"city": "VENTURA",
"state": "CA",
"postal_code": "930041084",
"telephone_number": "805-383-3669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1756 S LEWIS RD",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930128520",
"telephone_number": "805-383-3669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-06",
"last_updated": "2021-08-23",
"certification_date": "2021-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "4749",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REHAB ACTIVITY LEADER",
"identifier": "174400000X",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camarillo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.