MEDICARE: NICOLLE DELEO LMHC PSYD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	10032	FL
2	103TC0700X	Clinical Psychologist	8799	FL

General Provider Information

NPI Number	:	1063750347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLLE DELEO LMHC PSYD PA

Provider Business Mailing Address
First Line	:	2755 E OAKLAND PARK BLVD
Second Line	:	SUITE 225
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1637
Country	:	US
Telephone Number	:	954-260-8790
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 EAST OAKLAND PARK BLVD.
Second Line	:	SUITE 225
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33307-2841
Country	:	US
Telephone Number	:	954-260-8790
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. NICOLLE A. DELEO
Credential	:	PSYD, LMHC
Telephone Number	:	954-260-8790

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	03/24/2017

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