Provider Demographics
NPI:1629433867
Name:NICOLAS, ROLLAND (MSW)
Entity Type:Individual
Prefix:
First Name:ROLLAND
Middle Name:
Last Name:NICOLAS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 LAMPLIGHTER DR NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7936
Mailing Address - Country:US
Mailing Address - Phone:321-313-1669
Mailing Address - Fax:
Practice Address - Street 1:1156 LAMPLIGHTER DR NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7936
Practice Address - Country:US
Practice Address - Phone:321-313-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker