Provider Demographics
NPI:1194705939
Name:ST GEORGE, NINA (MSW)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:ST GEORGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 HIGHWAY 34
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-6613
Mailing Address - Country:US
Mailing Address - Phone:732-264-8878
Mailing Address - Fax:732-566-7727
Practice Address - Street 1:22 CENTER ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2219
Practice Address - Country:US
Practice Address - Phone:732-264-8878
Practice Address - Fax:732-566-7727
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014293001041C0700X
NJ37FI00139400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist