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General NPI Number Information
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NPI Number | 1609136571
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Entity Type | Individual
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Provider Name | NICOLE DIZON WITKIN PSY.D
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Gender | Female
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 317 14TH ST SUITE E
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City | DEL-MAR
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State | CA
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Zip | 92014
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Country | US
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Telephone | 858-876-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 317 14TH ST STE E
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City | DEL MAR
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State | CA
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Zip | 92014-2554
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Country | US
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Telephone | 858-876-7728
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32204
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License Number State | CA
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