Provider Demographics
NPI:1831212083
Name:NAZARIO, ANDRES JR (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:NAZARIO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 W COMMERCIAL BLVD
Mailing Address - Street 2:CONTINENTAL OFFICE PLAZA SUITE 100
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2100
Mailing Address - Country:US
Mailing Address - Phone:954-721-5331
Mailing Address - Fax:954-721-5331
Practice Address - Street 1:6635 W COMMERCIAL BLVD
Practice Address - Street 2:CONTINENTAL OFFICE PLAZA SUITE 100
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2100
Practice Address - Country:US
Practice Address - Phone:954-721-5331
Practice Address - Fax:954-721-5331
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4709103T00000X
FLMT361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist