Provider Demographics
NPI:1619378908
Name:NELSON, SANTRICOA (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SANTRICOA
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 WORTHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-9742
Mailing Address - Country:US
Mailing Address - Phone:321-356-4736
Mailing Address - Fax:
Practice Address - Street 1:214 E WASHINGTON ST
Practice Address - Street 2:APT A
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-9227
Practice Address - Country:US
Practice Address - Phone:407-734-3338
Practice Address - Fax:407-377-7517
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161551041C0700X
FLN425792713420171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator