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General NPI Number Information
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NPI Number | 1174831176
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Entity Type | Individual
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Provider Name | MAGALIE NICOLAS LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 190 MCIVER LN
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City | ROCKLEDGE
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State | FL
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Zip | 32955-5412
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Country | US
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Telephone | 321-631-8569
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Fax | 321-631-6530
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Provider Business Mailing Address
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Address Line | 6461 BORASCO DR UNIT # 2802
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City | MELBOURNE
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State | FL
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Zip | 32940-6143
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Country | US
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Telephone | 305-849-2559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10033
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License Number State | FL
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