Provider Demographics
NPI:1841528874
Name:DELEO, NICOLLE ANNE (PSY D)
Entity type:Individual
Prefix:MS
First Name:NICOLLE
Middle Name:ANNE
Last Name:DELEO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:MS
Other - First Name:NICOLLE
Other - Middle Name:ANNE
Other - Last Name:DELEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:2755 E OAKLAND PARK BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1629
Mailing Address - Country:US
Mailing Address - Phone:954-990-7673
Mailing Address - Fax:
Practice Address - Street 1:2755 E OAKLAND PARK BLVD STE 225
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1629
Practice Address - Country:US
Practice Address - Phone:954-440-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10032101YM0800X
FLPY8799103T00000X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist