Provider Demographics
NPI:1710293527
Name:NIKPOUR, SHAHLA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAHLA
Middle Name:
Last Name:NIKPOUR
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 1:12501 SW 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4609
Mailing Address - Country:US
Mailing Address - Phone:248-385-7790
Mailing Address - Fax:
Practice Address - Street 1:12501 SW 108TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4609
Practice Address - Country:US
Practice Address - Phone:248-385-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL125721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12572OtherSTATE OF FLORIDA
NY081165OtherLICENSE #