Healthcare Provider Details

I. General information

NPI: 1144131079
Provider Name (Legal Business Name): TIMOTHY NEE LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MAPLEWOOD AVE STE 4
MAPLEWOOD NJ
07040-2510
US

IV. Provider business mailing address

85 ESSEX AVE
MONTCLAIR NJ
07042-4124
US

V. Phone/Fax

Practice location:
  • Phone: 973-902-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: