Healthcare Provider Details

I. General information

NPI: 1770442345
Provider Name (Legal Business Name): NICOLE CHERRIE LOWE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 BROADWAY ST STE 100
VALLEJO CA
94589-2227
US

IV. Provider business mailing address

1761 BROADWAY ST STE 100
VALLEJO CA
94589-2227
US

V. Phone/Fax

Practice location:
  • Phone: 707-645-2700
  • Fax:
Mailing address:
  • Phone: 707-645-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number136502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: