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NPI Code Detail

MEDICARE: MS. NICOLE EILEEN FLORES LCSW

MEDICARE: MS. NICOLE EILEEN FLORES 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
11041C0700XClinical Social Worker6801086514MI

General Provider Information

NPI Number : 1912056250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE EILEEN FLORES LCSW
Provider Business Mailing Address
First Line : 3440 MAHOPAC DR
Second Line :
City : LAKE ORION
State : MI
Zip : 48360-1526
Country : US
Telephone Number : 248-891-7379
Fax Number :
Provider Business Practice Location Address
First Line : 3440 MAHOPAC DR
Second Line :
City : LAKE ORION
State : MI
Zip : 48360-1526
Country : US
Telephone Number : 248-891-7379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 01/21/2021

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