Healthcare Provider Details

I. General information

NPI: 1235421298
Provider Name (Legal Business Name): NICOLE YEE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date: 06/21/2011
Reactivation Date: 07/20/2011

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

PO BOX 720055
SAN FRANCISCO CA
94172-0055
US

V. Phone/Fax

Practice location:
  • Phone: 415-996-8261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: