Raymond Joseph Nickerson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY31676 Issued in CA

Practice address

3095 Richmond Pkwy Ste 201
Richmond, CA 94806-5878

Phone

(510) 282-4211

NPI assigned

Jul 12, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

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.

• Portia Bell Hume Behavioral Health and Training Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Concord, CA
  • NPI 1760489439
  Medicare reassignment NPD
• Portia Bell Hume Behavioral Health & Training Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Richmond, CA
  • NPI 1083060990
  NPD

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1982969226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 LAKESIDE DR",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948065774",
            "telephone_number": "510-262-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 RICHMOND PKWY STE 201",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948065878",
            "telephone_number": "510-282-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "RAYMOND",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-12",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT47165",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY31676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "1245393503",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Nguyen, PHARM D
• Thuy Minh Nguyen
• Franca Voke Niameh, PSYD
• Deborah A Nicholas, N.P.
• Elaine J Nicholas
• Nimara Digital Inc
• Michelle Nobori
• Caitlin Nofflett, MD, ED.S
• Logan Noone, DO
• Nora M Norback, RD

• Clinical Psychologist in Richmond, CA
• Providers in Richmond, 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 27, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.