Provider Demographics
NPI:1285090431
Name:NELSON SR, THEODORE SCOTT SR (LCSW)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:SCOTT
Last Name:NELSON SR
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 OSCEOLA CIR W
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2956
Mailing Address - Country:US
Mailing Address - Phone:954-965-4414
Mailing Address - Fax:954-965-4414
Practice Address - Street 1:6528 OSCEOLA CIR W
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2956
Practice Address - Country:US
Practice Address - Phone:954-965-4414
Practice Address - Fax:954-965-4414
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW58131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical