Provider Demographics
NPI:1942611876
Name:NELSON, PAULA FLEISHER (EDD, LCSW, CAP, CET)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:FLEISHER
Last Name:NELSON
Suffix:
Gender:F
Credentials:EDD, LCSW, CAP, CET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 LAKE POLO DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1700
Mailing Address - Country:US
Mailing Address - Phone:813-951-8889
Mailing Address - Fax:
Practice Address - Street 1:1340 LAKE POLO DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1700
Practice Address - Country:US
Practice Address - Phone:813-951-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4465101YA0400X
FLSW91011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)