| Doctor Name: | MS. MOLLY BETH NICKERSON |
| NPI Number: | 1053560573 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | ITIN |
| Business Practice Address: | 601 S Prospect Ave Unit 306 Redondo Beach, CA - 902774403 |
| Business Phone Number: | 3109015176 |
| Business Fax Number: | |
| Mailing Address: | 601 S Prospect Ave Unit 306, REDONDO BEACH |
| State: | CA |
| Postal Code: | 902774403 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/09/2008 |
| NPI Last Update Date: | 09/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | ITIN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |