Provider Demographics
NPI:1679024012
Name:CAMERON, NICHOLA SYBONIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLA
Middle Name:SYBONIE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICKY
Other - Middle Name:
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2701 W OAKLAND PARK BLVD STE 410-4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1388
Mailing Address - Country:US
Mailing Address - Phone:954-533-4828
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAKLAND PARK BLVD STE 410-4
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311
Practice Address - Country:US
Practice Address - Phone:954-533-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCCMS100395171M00000X
FLSW118281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator