Provider Demographics
NPI:1700454105
Name:OVEDIA, NICOLE RENEE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:RENEE
Last Name:OVEDIA
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 1:2250 NW 136 AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2586
Mailing Address - Country:US
Mailing Address - Phone:561-762-0027
Mailing Address - Fax:
Practice Address - Street 1:936 KOKOMO KEY LN FL 33483
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6031
Practice Address - Country:US
Practice Address - Phone:561-762-0027
Practice Address - Fax:954-212-5757
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical