Provider Demographics
NPI:1215655634
Name:DEAN, NICOLE C
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:C
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 SW 113TH PL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:FL
Mailing Address - Zip Code:33597-7308
Mailing Address - Country:US
Mailing Address - Phone:813-355-1113
Mailing Address - Fax:
Practice Address - Street 1:36156 GRESHAM RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:FL
Practice Address - Zip Code:33597-9287
Practice Address - Country:US
Practice Address - Phone:813-449-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health