Nan Jacobson Wise, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC00187000 Issued in NJ

Practice address

15 Village PLZ
Lower Level
South Orange, NJ 07079-2818

Phone

(973) 632-0625

NPI assigned

Feb 8, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922148832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 VILLAGE PLZ",
            "address_2": "LOWER LEVEL",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792818",
            "telephone_number": "973-632-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 VILLAGE PLZ",
            "address_2": "LOWER LEVEL",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792818",
            "telephone_number": "973-632-0625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON WISE",
        "first_name": "NAN",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC00187000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.