DR. NICOLE WOLLER (NPI# 1881735819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881735819 |
| Entity Type | Individual |
| Full Name | DR. NICOLE WOLLER |
| Credential | PH.D., LCSW |
| Practice Address |
5818 Se Agnew Rd Belleview FL 34420-4020 |
| Mailing Address |
2735 Se 140th Pl Summerfield FL 34491-2877 |
| Practice Telephone | 5617061004 |
| Practice Fax Number | 5618920268 |
| Mailing Telephone | 5617155910 |
| Mailing Fax Number | 5618920268 |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2020-04-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| N | 103TF0200X |
Psychologist Specialization: Forensic |
Behavioral Health & Social Service Providers | ||
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
SW8553 | FL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 767023100 | 05 | |
| FL | CAQH | 11758162 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 123 Nw 13th St # 111, Boca Raton, FL 334321641 | 5617061004 | 5618920268 |
| 2735 Se 140th Pl, Summerfield, FL 344912877 | 5617155910 | |
| 4100 Okeechobee Blvd Ste 170, West Palm Beach, FL 334093204 | 5617155910 | 5618920268 |
| Street Address |
5818 SE AGNEW RD |
| City | BELLEVIEW |
| State | FL |
| Zip Code | 34420-4020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881216877 | Pediatric Behavioral Health Associates, Inc. | Case Manager/Care Coordinator | 5818 Se Agnew Rd, Belleview, FL 34420-4020 | 2020-05-12 |
| 1861953523 | Pediatric Behavioral Health Associates, Inc. | Psychologist | 5818 Se Agnew Rd, Belleview, FL 34420-4020 | 2019-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881227726 | Madison Ruth Oglesby | Behavior Technician | 10252 S Us Hwy 441 Units 3 4, Belleview, FL 34420 | 2020-02-19 |
| 1104458496 | Patricia A Jackson | Behavior Technician | 10252 S Hwy 441, Unit 3, Belleview, FL 34420 | 2020-02-05 |
| 1891251781 | Pamela M Swiss | Behavior Technician | 10252 S Hwy 441 Unit 3 and 4, Belleview, FL 34420 | 2019-02-15 |
| 1417412834 | Ashlynn Shearer | Behavior Technician | 10252 S Us Hwy 441, Units 3 & 4, Belleview, FL 34420 | 2019-02-11 |
| 1083178313 | Sheila Bush | Technician | 12791 Se 47th Ave, Belleview, FL 34420 | 2019-01-31 |
| 1124579974 | Tamara Lopez Diaz, Md. Pa | Family Medicine | 12301 Se Us Highway 441 Ste C, Belleview, FL 34420 | 2016-10-17 |
| 1780043992 | Katelyn Garrett | Registered Nurse | 11855 Se 74th Terrace, Belleview, FL 34420 | 2016-02-16 |
| 1982092458 | Tracy Mattia | Pharmacist | 11310 Se Us Hwy 301, Belleview, FL 34420 | 2015-01-06 |
| 1245666171 | Hayden Lee Durham I | Pharmacist | 10762 South Us 441, Belleview, FL 34420 | 2013-09-24 |
| 1285060608 | Cindy Marlene Merritt | Pharmacist | 10762 Se Hwy 441, Belleview, FL 34420 | 2013-09-17 |
| Find all providers in zip 34420 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013984079 | Community Links Inc | Social Worker | 10117 Se Us Highway 441, Belleview, FL 34420-2809 | 2006-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679303 | Kamarie Lee Larson | Social Worker | 913 Gulf Breeze Pkwy Ste 26b, Gulf Breeze, FL 32561-4731 | 2020-11-08 |
| 1023619772 | Nichole Goff | Social Worker | 12151 Waterstone Ct Apt 826, Orlando, FL 32825-7035 | 2020-11-07 |
| 1356942262 | Shirley Roseman | Social Worker | 1450 E Sample Rd Apt 101, Pompano Beach, FL 33064-6267 | 2020-11-06 |
| 1760083729 | Phoenix Marie Klemann | Social Worker | 3311 Mona Dr, Navarre, FL 32566-9742 | 2020-11-05 |
| 1679174726 | Violett Counseling & Consulting Services LLC | Social Worker | 30 Wisteria Dr, Ormond Beach, FL 32176-2408 | 2020-11-05 |
| 1336740422 | Marissa Pinto | Social Worker | 3642 Eldron Ave, North Port, FL 34286-7453 | 2020-11-04 |
| 1710588991 | Mario Jesus Noguera | Social Worker | 18179 Nw 73rd Ave, Hialeah, FL 33015-6198 | 2020-11-04 |
| 1801497185 | Andrey Davydov | Social Worker | 3800 N Hills Dr Apt 106, Hollywood, FL 33021-2541 | 2020-11-04 |
| 1902407299 | Beverly Diane Sweeting | Social Worker | 10961 Sw Ivory Springs Ln, Port St Lucie, FL 34987-7710 | 2020-11-04 |
| 1174124622 | Cardinal Counseling Services, LLC | Social Worker | 2161 16th Ave Sw, Naples, FL 34117-4338 | 2020-11-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.