Healthcare Provider Details

I. General information

NPI: 1033252283
Provider Name (Legal Business Name): MISOOK OH NIERODZIK PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N GRAND AVE STE 212
WEST COVINA CA
91791-1757
US

IV. Provider business mailing address

150 N GRAND AVE STE 212
WEST COVINA CA
91791-1757
US

V. Phone/Fax

Practice location:
  • Phone: 626-915-2110
  • Fax:
Mailing address:
  • Phone: 626-915-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC43621
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: