Healthcare Provider Details

I. General information

NPI: 1447763586
Provider Name (Legal Business Name): JOSHUA AARON NEITLICH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2017
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12554 NAUTILUS CIR
PALM BEACH GARDENS FL
33412-2489
US

IV. Provider business mailing address

12554 NAUTILUS CIR
PALM BEACH GARDENS FL
33412-2489
US

V. Phone/Fax

Practice location:
  • Phone: 203-993-7809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009994
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: