Provider Demographics
NPI:1063559359
Name:NIES, DIANE L (LCSW LCADC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:L
Last Name:NIES
Suffix:
Gender:F
Credentials:LCSW LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-1901
Mailing Address - Country:US
Mailing Address - Phone:973-686-2227
Mailing Address - Fax:973-686-2240
Practice Address - Street 1:70 SPARTA AVE
Practice Address - Street 2:STE 104
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1760
Practice Address - Country:US
Practice Address - Phone:973-728-3938
Practice Address - Fax:973-728-7913
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00109100101YA0400X
NJ44SC052423001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
468737000OtherMAGELLAN
099713Medicare ID - Type Unspecified