Provider Demographics
NPI:1487702627
Name:WITTEBOON, NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:WITTEBOON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:21301 POWERLINE RD
Mailing Address - Street 2:STE 304
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2391
Mailing Address - Country:US
Mailing Address - Phone:954-263-4400
Mailing Address - Fax:
Practice Address - Street 1:2855 NORTH UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1403
Practice Address - Country:US
Practice Address - Phone:954-344-9825
Practice Address - Fax:954-757-3232
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW33511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical