Provider Demographics
NPI:1104325679
Name:CARLISI, NICOLE (LMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CARLISI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CAT ROCK LN
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2874
Mailing Address - Country:US
Mailing Address - Phone:561-379-3990
Mailing Address - Fax:
Practice Address - Street 1:153 CAT ROCK LN
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2874
Practice Address - Country:US
Practice Address - Phone:561-379-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health