Provider Demographics
NPI:1548695059
Name:NICHOLAS, ROY PETER (MSW)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:PETER
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 NW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2738
Mailing Address - Country:US
Mailing Address - Phone:754-245-2272
Mailing Address - Fax:
Practice Address - Street 1:1925 S PERIMETER RD STE 120
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-7123
Practice Address - Country:US
Practice Address - Phone:954-958-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical