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General NPI Number Information
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NPI Number | 1619378908
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Entity Type | Individual
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Provider Name | SANTRICOA NELSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 214 E WASHINGTON ST APT A
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City | MINNEOLA
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State | FL
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Zip | 34715-9227
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Country | US
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Telephone | 407-734-3338
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Fax | 407-377-7517
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Provider Business Mailing Address
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Address Line | 4227 WORTHINGTON PL
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City | MASCOTTE
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State | FL
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Zip | 34753-9742
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Country | US
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Telephone | 321-356-4736
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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 | 16155
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | N425792713420
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License Number State | FL
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