Provider Demographics
NPI:1144619453
Name:NELSON, NANDI (LCSW, BCBA)
Entity Type:Individual
Prefix:
First Name:NANDI
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 S HARRISON ST STE 311
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1960
Mailing Address - Country:US
Mailing Address - Phone:862-253-3109
Mailing Address - Fax:
Practice Address - Street 1:280 S HARRISON ST STE 311
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:862-253-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010975941041C0700X
1-15-20802103K00000X
NJ44SC057646001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical