Provider Demographics
NPI:1487715611
Name:NISHINA, SEIJIRO (PSYD/LMFT)
Entity type:Individual
Prefix:
First Name:SEIJIRO
Middle Name:
Last Name:NISHINA
Suffix:
Gender:M
Credentials:PSYD/LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD STE P296
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3904
Mailing Address - Country:US
Mailing Address - Phone:408-800-5366
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE A-101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-800-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC50945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health