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NPI Code Detail

MEDICARE: ROY PETER NICHOLAS MSW

MEDICARE: ROY PETER NICHOLAS MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1548695059
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY PETER NICHOLAS MSW
Provider Business Mailing Address
First Line : 4460 NW 61ST ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33319-2738
Country : US
Telephone Number : 754-245-2272
Fax Number :
Provider Business Practice Location Address
First Line : 1925 S PERIMETER RD STE 120
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-7123
Country : US
Telephone Number : 954-958-0988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2013
Last Update Date : 09/04/2013

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Directions to “ ROY PETER NICHOLAS MSW” Practice Location

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