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General NPI Number Information
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NPI Number | 1588709083
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Entity Type | Organization
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Legal Business Name | NICOLE WITTEBOON, INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 2855 NORTH UNIVERSITY DRIVE SUITE 200
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-1403
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Country | US
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Telephone | 954-344-9825
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Fax | 954-757-3232
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Provider Business Mailing Address
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Address Line | 2855 NORTH UNIVERSITY DRIVE SUITE 200
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-1403
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Country | US
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Telephone | 954-344-9825
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Fax | 954-757-3232
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NICOLE WEINER
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Credential | LCWS
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Telephone | 954-344-9825
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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 | SW3351
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License Number State | FL
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