Provider Demographics
NPI:1063579167
Name:WARD, NANCY ILENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ILENE
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WETHERHILL WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1607
Mailing Address - Country:US
Mailing Address - Phone:732-585-3259
Mailing Address - Fax:
Practice Address - Street 1:12 STULTS RD STE 123
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1549
Practice Address - Country:US
Practice Address - Phone:732-372-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047754001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ201535036OtherEIN