Healthcare Provider Details

I. General information

NPI: 1407028160
Provider Name (Legal Business Name): MARIA SUE NIELSEN MSW, LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 09/29/2026
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 N 117TH AVE
OMAHA NE
68164-3670
US

IV. Provider business mailing address

2126 N 117TH AVE
OMAHA NE
68164-3670
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-1617
  • Fax: 402-934-5228
Mailing address:
  • Phone: 402-934-1617
  • Fax: 402-934-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1454
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1396
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: