Healthcare Provider Details

I. General information

NPI: 1255766432
Provider Name (Legal Business Name): ABBY BREITMAN NICHOLSON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY RAE BREITMAN AMFT

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MANOR PLAZA
PACIFICA CA
94044
US

IV. Provider business mailing address

PO BOX 641841
SAN FRANCISCO CA
94109
US

V. Phone/Fax

Practice location:
  • Phone: 415-295-2248
  • Fax:
Mailing address:
  • Phone: 415-295-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: