Provider Demographics
NPI:1770339772
Name:MARDICE-JOSEPH, NATHALIE CARMELLE
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:CARMELLE
Last Name:MARDICE-JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W OAKLAND PARK BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1389
Mailing Address - Country:US
Mailing Address - Phone:954-533-4828
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAKLAND PARK BLVD STE 400
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1389
Practice Address - Country:US
Practice Address - Phone:954-533-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW227391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical