Provider Demographics
NPI:1073245718
Name:NIETO, ANTHONY JUDE (MA, LAC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JUDE
Last Name:NIETO
Suffix:
Gender:M
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 BLOOMFIELD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7131
Mailing Address - Country:US
Mailing Address - Phone:973-852-8430
Mailing Address - Fax:973-830-3180
Practice Address - Street 1:1120 BLOOMFIELD AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7131
Practice Address - Country:US
Practice Address - Phone:973-852-8430
Practice Address - Fax:973-830-3180
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00552900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health