| Doctor Name: | ELIZABETH L. NICKELS |
| NPI Number: | 1184882607 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., PSY.D. |
| License Number: | PSY22119 |
| Business Practice Address: | 1440 40th St Emeryville, CA - 946083552 |
| Business Phone Number: | 5105948800 |
| Business Fax Number: | 5102506923 |
| Mailing Address: | 2662 Wallace St, OAKLAND |
| State: | CA |
| Postal Code: | 946063346 |
| Phone Number: | 5104142416 |
| Fax Number: | 5102506923 |
| NPI Enumeration Date: | 05/30/2008 |
| NPI Last Update Date: | 01/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY22119 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |