Healthcare Provider Details

I. General information

NPI: 1609929140
Provider Name (Legal Business Name): THOMAS JAMES NOLAN JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ST HWY 17 N SUITE 313
PARAMUS NJ
07652-2644
US

IV. Provider business mailing address

12 RTE 17 NORTH SUITE 313
PARAMUS NJ
07652-2644
US

V. Phone/Fax

Practice location:
  • Phone: 201-368-2626
  • Fax: 201-368-0055
Mailing address:
  • Phone: 201-368-2626
  • Fax: 201-368-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01389700
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: