Provider Demographics
NPI:1689869752
Name:MACCOLL, NANCY (LMSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MACCOLL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 N DIXIE HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3928
Mailing Address - Country:US
Mailing Address - Phone:954-226-9585
Mailing Address - Fax:
Practice Address - Street 1:4849 N DIXIE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3928
Practice Address - Country:US
Practice Address - Phone:954-226-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW110111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244019Medicaid
FL009804200Medicaid
FLIJ532ZMedicare PIN