Healthcare Provider Details

I. General information

NPI: 1982934048
Provider Name (Legal Business Name): NIETO COUNSELING & PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W PASSAIC ST SUITE 36
ROCHELLE PARK NJ
07662-3105
US

IV. Provider business mailing address

151 W PASSAIC ST SUITE 36
ROCHELLE PARK NJ
07662-3105
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-1826
  • Fax: 201-368-2438
Mailing address:
  • Phone: 201-843-1826
  • Fax: 201-368-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00851800
License Number StateNJ

VIII. Authorized Official

Name: MS. YAZMIRA T NIETO-CRUZ
Title or Position: PSYCHOTHERAPIST
Credential: L.C.S.W.
Phone: 201-843-1826