Provider Demographics
NPI:1730248519
Name:BERLANT, NICOLE ERICA (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ERICA
Last Name:BERLANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:KAISER PERMANENTE
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-746-3956
Mailing Address - Fax:916-746-3998
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-746-3956
Practice Address - Fax:916-746-3998
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical