Provider Demographics
NPI:1467331744
Name:LIZ NICKOLE THERAPY, A LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CO
Entity type:Organization
Organization Name:LIZ NICKOLE THERAPY, A LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-766-2940
Mailing Address - Street 1:4750 ALMADEN EXPY STE 124-335
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2052
Mailing Address - Country:US
Mailing Address - Phone:408-766-2940
Mailing Address - Fax:
Practice Address - Street 1:4750 ALMADEN EXPY STE 124-335
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2052
Practice Address - Country:US
Practice Address - Phone:408-766-2940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty