Provider Demographics
NPI:1154584894
Name:NIEMEYER, ERIC JOHN (PSY D)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHN
Last Name:NIEMEYER
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARKSHORE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4726
Mailing Address - Country:US
Mailing Address - Phone:530-400-0620
Mailing Address - Fax:
Practice Address - Street 1:421 NUT TREE ROAD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688
Practice Address - Country:US
Practice Address - Phone:707-624-7500
Practice Address - Fax:707-624-7501
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TH0100X
CA25842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service