Jose J Nieves, LCSW

Individual provider Active NPI Clinical Social Worker · Haskell, NJ

NPI 1124483334 · NPPES record last updated Aug 9, 2021

Key facts

NPI
1124483334
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
44SC05765400 (NJ)
Practice address
1069 Ringwood Ave Ste 301
Haskell, NJ 07420-1452
Phone
(973) 413-7612
NPI assigned
Dec 15, 2015
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
44SL06072300NJMDSocial Worker
44SC05765400NJMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 44SL06072300 NJ
Clinical Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP
1041C0700X 44SC05765400 NJ Yes

Addresses

Primary practice location

1069 Ringwood Ave Ste 301
Haskell, NJ 07420-1452

Mailing address

1069 Ringwood Ave Ste 301
Haskell, NJ 07420-1452
Phone (973) 413-7612

Other providers in Haskell, NJ

All providers in Haskell, NJ · Clinical Social Worker in New Jersey

Sources for this page

Verify at the official NPI Registry.