Healthcare Provider Details

I. General information

NPI: 1174922736
Provider Name (Legal Business Name): LINDA J NICHOLSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SYBELIA AVE STE 150
MAITLAND FL
32751-4773
US

IV. Provider business mailing address

5840 RED BUG LAKE RD # 1526
WINTER SPRINGS FL
32708-5011
US

V. Phone/Fax

Practice location:
  • Phone: 407-986-7442
  • Fax: 407-790-7098
Mailing address:
  • Phone: 407-389-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: