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General NPI Number Information
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NPI Number | 1063750347
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Entity Type | Organization
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Legal Business Name | NICOLLE DELEO LMHC PSYD PA
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 2755 EAST OAKLAND PARK BLVD. SUITE 225
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City | FORT LAUDERDALE
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State | FL
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Zip | 33307-2841
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Country | US
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Telephone | 954-260-8790
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Fax |
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Provider Business Mailing Address
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Address Line | 2755 E OAKLAND PARK BLVD SUITE 225
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1637
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Country | US
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Telephone | 954-260-8790
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. NICOLLE A. DELEO
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Credential | PSYD, LMHC
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Telephone | 954-260-8790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10032
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8799
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License Number State | FL
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