Dwayne Nickerson

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT96210 Issued in CA

Practice address

4193 Flat Rock Dr Ste 200
Riverside, CA 92505-7113

Phone

(805) 242-4851

Fax

(951) 329-5800

NPI assigned

Sep 26, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Marriage & Family Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1780011437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4193 FLAT ROCK DR STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925057113",
            "telephone_number": "805-242-4851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4193 FLAT ROCK DR STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925057113",
            "telephone_number": "805-242-4851",
            "fax_number": "951-329-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 S Miller St Ste 121",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "93454",
            "country_code": "US",
            "telephone_number": "310-897-0140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3787 S Vermont Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900074203",
            "country_code": "US",
            "telephone_number": "323-766-2345 x2207",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 S Miller St Ste 112",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "93454",
            "country_code": "US",
            "telephone_number": "805-361-0118 x0118",
            "fax_number": "805-332-3057",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 S Miller St Ste 112",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "93454",
            "country_code": "US",
            "telephone_number": "805-361-0118 x0118",
            "fax_number": "805-332-3057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "DWAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-26",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT96210",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahsa Niakan, DDS
• Coqueece Nichols
• Jessica Christine Nichols
• Kyla Nichols
• Rachel Nicholson
• Nickes Medical Supply, LLC.
• Kenneth Nickson, M.D
• Christofer Michael Nicodemus
• Kristine Geronimo Nicolas, MD
• Micaela Nicolas

• Marriage & Family Therapist in Riverside, CA
• Providers in Riverside, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.