Provider Demographics
NPI:1447859814
Name:DISHMAN, NICOLE CARDEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CARDEN
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DEANNE
Other - Last Name:CARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 CHRISTINA LANDING DR APT 1902
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5278
Mailing Address - Country:US
Mailing Address - Phone:610-986-3830
Mailing Address - Fax:
Practice Address - Street 1:300 CREEK VIEW RD STE 101A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-8547
Practice Address - Country:US
Practice Address - Phone:302-635-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical