Provider Demographics
NPI:1134517824
Name:DA LIMA LEITAO, NICOLE MARISE
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARISE
Last Name:DA LIMA LEITAO
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 1:9123 E MISSISSIPPI AVE APT 7-304
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2092
Mailing Address - Country:US
Mailing Address - Phone:619-504-0204
Mailing Address - Fax:
Practice Address - Street 1:9123 E MISSISSIPPI AVE APT 7-304
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2092
Practice Address - Country:US
Practice Address - Phone:619-504-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-03
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-10014103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst