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NPI Code Detail

MEDICARE: DR. JEANINE DONALDSON NIX PH.D. LCSW

MEDICARE: DR. JEANINE DONALDSON NIX PH.D. LCSW
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
1101YM0800XMental Health CounselorSW1166FL
21041C0700XClinical Social WorkerSW1166FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528197654
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEANINE DONALDSON NIX PH.D. LCSW
Provider Business Mailing Address
First Line : 4740 N STATE ROAD 7
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33319-5839
Country : US
Telephone Number : 954-486-4005
Fax Number :
Provider Business Practice Location Address
First Line : 1957 JACKSON ST
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33020-5021
Country : US
Telephone Number : 954-921-2600
Fax Number : 954-497-3857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 10/10/2017

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