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1700921038 NPI number — KATHARINE MARIE NICODEMUS PSYD

NPI Number: 1700921038
Health Care Provider/Practitioner: KATHARINE MARIE NICODEMUS PSYD

Information about “1700921038” NPI (KATHARINE MARIE NICODEMUS PSYD) exists in 1700921038 in HTML format HTML  |  1700921038 in plain Text format TXT  |  1700921038 in PDF (Portable Document Format) PDF  |  1700921038 in an XML format XML  formats.

NPI Number : 1700921038 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700921038",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICODEMUS",
    "FirstName": "KATHARINE",
    "MiddleName": "MARIE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4011 SPRINGFIELD LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENVILLE",
    "MailingAddressStateName": "DE",
    "MailingAddressPostalCode": "19807-2251",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "302-645-1300",
    "MailingAddressFaxNumber": "302-645-1317",
    "FirstLinePracticeLocationAddress": "16529 COASTAL HWY",
    "SecondLinePracticeLocationAddress": "SUITE 113",
    "PracticeLocationAddressCityName": "LEWES",
    "PracticeLocationAddressStateName": "DE",
    "PracticeLocationAddressPostalCode": "19958-3605",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "302-645-1300",
    "PracticeLocationAddressFaxNumber": "302-645-1317",
    "EnumerationDate": "02/21/2007",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103G00000X",
          "TaxonomyName": "Clinical Neuropsychologist",
          "LicenseNumber": "BL-0000656",
          "LicenseNumberStateCode": "DE",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "BL-0000656",
          "LicenseNumberStateCode": "DE",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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