Provider Demographics
NPI:1073187035
Name:NICASTRO-MAGGIO, NICOLE MARIE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:NICASTRO-MAGGIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:NICASTRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:639 NE 17TH WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3428
Mailing Address - Country:US
Mailing Address - Phone:954-439-1881
Mailing Address - Fax:
Practice Address - Street 1:639 NE 17TH WAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3428
Practice Address - Country:US
Practice Address - Phone:954-439-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health