Provider Demographics
NPI:1629867072
Name:NORDELUS, WIDLINE (LMFT)
Entity type:Individual
Prefix:
First Name:WIDLINE
Middle Name:
Last Name:NORDELUS
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 NE 2ND TER
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3510
Mailing Address - Country:US
Mailing Address - Phone:754-203-5925
Mailing Address - Fax:
Practice Address - Street 1:4040 NE 2ND TER
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3510
Practice Address - Country:US
Practice Address - Phone:754-203-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist