Provider Demographics
NPI:1508108853
Name:CASTRO, NICOLE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:CASTRO
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 1:570 LORETTO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2102
Mailing Address - Country:US
Mailing Address - Phone:786-303-0389
Mailing Address - Fax:
Practice Address - Street 1:8100 SW 81ST DR
Practice Address - Street 2:SUITE 290
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-6603
Practice Address - Country:US
Practice Address - Phone:305-270-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 112831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical