Provider Demographics
NPI:1902087364
Name:DHAMNASKAR, NICOLE ALEXIS (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXIS
Last Name:DHAMNASKAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALEXIS
Other - Last Name:LAPERDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2660 SHOFIELD CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8502
Mailing Address - Country:US
Mailing Address - Phone:760-815-0224
Mailing Address - Fax:510-268-0143
Practice Address - Street 1:35 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4058
Practice Address - Country:US
Practice Address - Phone:650-660-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288301041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical