Provider Demographics
NPI:1205864725
Name:NICHOLS, MIRIAM ANNETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:ANNETTE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1210 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3806
Mailing Address - Country:US
Mailing Address - Phone:305-788-3729
Mailing Address - Fax:305-535-8215
Practice Address - Street 1:3050 BISCAYNE BLVD
Practice Address - Street 2:SUITE 908
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4158
Practice Address - Country:US
Practice Address - Phone:305-788-3729
Practice Address - Fax:305-535-8215
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 46811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8402Medicare UPIN