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General NPI Number Information
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NPI Number | 1245624089
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Entity Type | Organization
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Legal Business Name | NANCY MACCOLL, L.C.S.W., LLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 1400 E OAKLAND PARK BLVD 100
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City | OAKLAND PARK
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State | FL
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Zip | 33334-4400
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Country | US
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Telephone | 954-226-9585
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 ENVIRON BLVD
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City | LAUDERHILL
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State | FL
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Zip | 33319-4280
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Country | US
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Telephone | 954-226-9585
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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 | NANCY MACCOLL
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Credential |
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Telephone | 954-226-9585
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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 | SW11011
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License Number State | FL
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