Provider Demographics
NPI:1982299905
Name:AVILES, NICOLLE A
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:A
Last Name:AVILES
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 1:2777 10TH AVE N APT 305
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6750
Mailing Address - Country:US
Mailing Address - Phone:561-644-3995
Mailing Address - Fax:
Practice Address - Street 1:8895 N MILITARY TRL STE 300C
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6279
Practice Address - Country:US
Practice Address - Phone:561-244-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical