Provider Demographics
NPI:1386046258
Name:DOW, NICOLE
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:DOW
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:KATHERINE
Other - Last Name:BRINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1417 ALLEGADO ALY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4547
Mailing Address - Country:US
Mailing Address - Phone:408-221-2119
Mailing Address - Fax:
Practice Address - Street 1:5825 PEBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4332
Practice Address - Country:US
Practice Address - Phone:408-221-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4754103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist