MEDICARE: NICOLE NGO ED.S., PPS, LEP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	4144	CA
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist	4144	CA
3	103TS0200X	School Psychologist	4144	CA
4	103T00000X	Psychologist	4144	CA

General Provider Information

NPI Number	:	1376398693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE NGO ED.S., PPS, LEP

Provider Business Mailing Address
First Line	:	3130 E 2ND ST APT 10
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-7316
Country	:	US
Telephone Number	:	714-487-9808
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 E 2ND ST APT 10
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-7316
Country	:	US
Telephone Number	:	714-487-9808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	04/19/2024

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