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General NPI Number Information
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NPI Number | 1700468311
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Entity Type | Individual
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Provider Name | DR. SIDNEY NICOLE GARDNER COLE
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Gender | Female
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 2815 MITCHELL DR STE 119
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City | WALNUT CREEK
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State | CA
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Zip | 94598-1622
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Country | US
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Telephone | 562-965-2806
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 61740
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City | IRVINE
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State | CA
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Zip | 92602-6058
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Country | US
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Telephone | 562-965-2806
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY34862
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License Number State | CA
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