| Doctor Name: | DR. GERALD DAVID NICKLEN |
| NPI Number: | 1558496919 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, LICSW |
| License Number: | LC302634 |
| Business Practice Address: | 9950 Us Highway 98 W Lot F6 Miramar Beach, FL - 325504994 |
| Business Phone Number: | 8505437776 |
| Business Fax Number: | |
| Mailing Address: | 9950 Us Highway 98 W Lot F6, MIRAMAR BEACH |
| State: | FL |
| Postal Code: | 325504994 |
| Phone Number: | 8505437776 |
| Fax Number: | |
| NPI Enumeration Date: | 02/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LC302634 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |