Provider Demographics
NPI:1043562432
Name:NEIDITZ, JOEL (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:NEIDITZ
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MENDUM ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1613
Mailing Address - Country:US
Mailing Address - Phone:617-325-9288
Mailing Address - Fax:
Practice Address - Street 1:33 MENDUM ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1613
Practice Address - Country:US
Practice Address - Phone:617-325-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015011041C0700X
MA3391151041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool