Provider Demographics
NPI:1679889059
Name:AGUIAR NICHOLAS, OCTAVIO (LMHC, CAP)
Entity type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:
Last Name:AGUIAR NICHOLAS
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 N. STATE ROAD 7, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-327-4060
Mailing Address - Fax:954-792-9122
Practice Address - Street 1:351 N. STATE ROAD 7, SUITE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-327-4060
Practice Address - Fax:954-792-9122
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10419171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006521000Medicaid