Provider Demographics
NPI:1063163483
Name:NEUFELD, NICOLE MARIE (RCSWI)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:NEUFELD
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 SW 95TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1878
Mailing Address - Country:US
Mailing Address - Phone:754-422-1352
Mailing Address - Fax:
Practice Address - Street 1:12417 SW 95TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1878
Practice Address - Country:US
Practice Address - Phone:754-422-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC312101YP2500X
FL224711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional