Healthcare Provider Details

I. General information

NPI: 1184156044
Provider Name (Legal Business Name): NICOLE MARIE PERA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N STATE ROAD 7 STE 120
LAUDERDALE LAKES FL
33319-5803
US

IV. Provider business mailing address

4740 N STATE ROAD 7 STE 201
LAUDERDALE LAKES FL
33319-5839
US

V. Phone/Fax

Practice location:
  • Phone: 954-730-7284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006198
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18920
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMH18920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: