Healthcare Provider Details

I. General information

NPI: 1124483334
Provider Name (Legal Business Name): JOSE J NIEVES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 RINGWOOD AVE STE 301
HASKELL NJ
07420-1452
US

IV. Provider business mailing address

1069 RINGWOOD AVE STE 301
HASKELL NJ
07420-1452
US

V. Phone/Fax

Practice location:
  • Phone: 973-413-7612
  • Fax:
Mailing address:
  • Phone: 973-413-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06072300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05765400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: