Provider Demographics
NPI:1508091646
Name:MACHADO, NICOLETTE LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:LEE
Last Name:MACHADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:LEE
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5600 S 59TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2386
Mailing Address - Country:US
Mailing Address - Phone:814-215-9590
Mailing Address - Fax:
Practice Address - Street 1:5600 S 59TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2386
Practice Address - Country:US
Practice Address - Phone:814-215-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127142104100000X
PACW0172881041C0700X
NE4099101YM0800X
NE1462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health