Provider Demographics
NPI:1902575483
Name:NITTO, OLIVIA VICTORIA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:VICTORIA
Last Name:NITTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CONGRESS AVE # 613
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8679
Mailing Address - Country:US
Mailing Address - Phone:561-654-8828
Mailing Address - Fax:
Practice Address - Street 1:1800 N CONGRESS AVE # 613
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8679
Practice Address - Country:US
Practice Address - Phone:561-654-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-22-60169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst