Provider Demographics
NPI:1003111097
Name:NEIFERT, ERIC JOEL (MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOEL
Last Name:NEIFERT
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 W END AVE
Mailing Address - Street 2:3
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2030
Mailing Address - Country:US
Mailing Address - Phone:570-573-4136
Mailing Address - Fax:570-622-9862
Practice Address - Street 1:1840 W END AVE
Practice Address - Street 2:3
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2030
Practice Address - Country:US
Practice Address - Phone:570-573-4136
Practice Address - Fax:570-622-9862
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA005767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional