Provider Demographics
NPI:1073015970
Name:KNIGHT, NINA (LSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:1704 MADALINE DR
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1374
Mailing Address - Country:US
Mailing Address - Phone:973-819-4682
Mailing Address - Fax:732-602-7771
Practice Address - Street 1:134 EVERGREEN PL STE 709
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2004
Practice Address - Country:US
Practice Address - Phone:973-447-4907
Practice Address - Fax:862-930-3482
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06289000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker