Provider Demographics
NPI:1154948982
Name:MAZAHIR, NICOLE LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LEE
Last Name:MAZAHIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LEE
Other - Last Name:MACWILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5257 KIRKWALL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:470-519-2061
Mailing Address - Fax:
Practice Address - Street 1:5257 KIRKWALL CIRCLE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:470-519-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058641001041C0700X
FLSW212551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical