Provider Demographics
NPI:1962947051
Name:NIESE, CARLA (LISW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:NIESE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N SUMMIT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1884
Mailing Address - Country:US
Mailing Address - Phone:419-693-9600
Mailing Address - Fax:
Practice Address - Street 1:830 N SUMMIT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1884
Practice Address - Country:US
Practice Address - Phone:419-693-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2021-04-20
Deactivation Date:2018-06-14
Deactivation Code:
Reactivation Date:2021-04-20
Provider Licenses
StateLicense IDTaxonomies
OHI.0700164104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker