Provider Demographics
NPI:1730281155
Name:ROUSIS, NICHOLAS ROUSIS (MED, MSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ROUSIS
Last Name:ROUSIS
Suffix:
Gender:M
Credentials:MED, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44231
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4231
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:
Practice Address - Street 1:1650 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1350
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8147
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-8966
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS329103TS0200X
FLSW61401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool