Provider Demographics
NPI:1497151161
Name:MAGILL, NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MAGILL
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 1:14710 VIA ESTRELLA PL
Mailing Address - Street 2:APT 302
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1661
Mailing Address - Country:US
Mailing Address - Phone:845-239-8707
Mailing Address - Fax:
Practice Address - Street 1:14710 VIA ESTRELLA PL
Practice Address - Street 2:APT 302
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1661
Practice Address - Country:US
Practice Address - Phone:845-239-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW136951041C0700X
NY084818-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical