Provider Demographics
NPI:1124483334
Name:NIEVES, JOSE J (LCSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:NIEVES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 RINGWOOD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1452
Mailing Address - Country:US
Mailing Address - Phone:973-413-7612
Mailing Address - Fax:
Practice Address - Street 1:1069 RINGWOOD AVE STE 301
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:NJ
Practice Address - Zip Code:07420-1452
Practice Address - Country:US
Practice Address - Phone:973-413-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06072300104100000X
NJ44SC057654001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker