Provider Demographics
NPI:1861878647
Name:CECIL, NICHOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:
Last Name:CECIL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 OAKDALE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6505
Mailing Address - Country:US
Mailing Address - Phone:818-778-1900
Mailing Address - Fax:
Practice Address - Street 1:9200 OAKDALE AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6505
Practice Address - Country:US
Practice Address - Phone:818-778-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35474103TC0700X, 103TM1800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities