Provider Demographics
NPI:1700468311
Name:COLE, SIDNEY NICOLE GARDNER
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:NICOLE GARDNER
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61740
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6058
Mailing Address - Country:US
Mailing Address - Phone:562-965-2806
Mailing Address - Fax:
Practice Address - Street 1:2815 MITCHELL DR STE 119
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-1622
Practice Address - Country:US
Practice Address - Phone:562-965-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical