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General NPI Number Information
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NPI Number | 1457133654
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Entity Type | Individual
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Provider Name | S NYCOLE BEARD ACSW
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Gender | Female
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 438 CAMINO DEL RIO S STE 106
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City | SAN DIEGO
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State | CA
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Zip | 92108-3546
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Country | US
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Telephone | 855-550-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 8409 TRIMMER WAY
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City | SACRAMENTO
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State | CA
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Zip | 95828-6310
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Country | US
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Telephone | 916-776-3001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 118404
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License Number State | CA
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