Provider Demographics
NPI:1295196277
Name:ST. JOHN, NICOLE DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:DENISE
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 VILLAGE SQUARE XING STE 211
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4540
Mailing Address - Country:US
Mailing Address - Phone:561-843-3357
Mailing Address - Fax:
Practice Address - Street 1:800 VILLAGE SQUARE CROSSING, SUITE 211
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-843-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11346101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)