Provider Demographics
NPI:1063750347
Name:NICOLLE DELEO LMHC PSYD PA
Entity type:Organization
Organization Name:NICOLLE DELEO LMHC PSYD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELEO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMHC
Authorized Official - Phone:954-260-8790
Mailing Address - Street 1:2755 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1637
Mailing Address - Country:US
Mailing Address - Phone:954-260-8790
Mailing Address - Fax:
Practice Address - Street 1:2755 EAST OAKLAND PARK BLVD.
Practice Address - Street 2:SUITE 225
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33307-2841
Practice Address - Country:US
Practice Address - Phone:954-260-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10032101YM0800X
FL8799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty