Provider Demographics
NPI:1699131367
Name:NUSSBAUM, CRAIG (LCSW)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:NUSSBAUM
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 1:128 IVINS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2924
Mailing Address - Country:US
Mailing Address - Phone:609-605-2847
Mailing Address - Fax:
Practice Address - Street 1:259 DELSEA DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9401
Practice Address - Country:US
Practice Address - Phone:856-881-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055553001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical