Provider Demographics
NPI:1477602720
Name:NICHOLAS, NINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2604
Mailing Address - Country:US
Mailing Address - Phone:561-776-1660
Mailing Address - Fax:561-863-3128
Practice Address - Street 1:5608 PGA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4121
Practice Address - Country:US
Practice Address - Phone:561-776-1660
Practice Address - Fax:561-863-3128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health