Provider Demographics
NPI:1932633955
Name:CHAVEZ, NICOLE (PSYD, MSW)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PSYD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SW 123RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2250
Mailing Address - Country:US
Mailing Address - Phone:786-973-4657
Mailing Address - Fax:
Practice Address - Street 1:2883 EXECUTIVE PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3662
Practice Address - Country:US
Practice Address - Phone:954-516-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst