Provider Demographics
NPI:1700921038
Name:NICODEMUS, KATHARINE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:MARIE
Last Name:NICODEMUS
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 1:4011 SPRINGFIELD LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2251
Mailing Address - Country:US
Mailing Address - Phone:302-645-1300
Mailing Address - Fax:302-645-1317
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:SUITE 113
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3605
Practice Address - Country:US
Practice Address - Phone:302-645-1300
Practice Address - Fax:302-645-1317
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEBL-0000656103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical