Provider Demographics
NPI:1154630523
Name:NATHAN, JOHN L (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:NATHAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PATCHIN PL
Mailing Address - Street 2:1R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8316
Mailing Address - Country:US
Mailing Address - Phone:212-243-3770
Mailing Address - Fax:
Practice Address - Street 1:6 PATCHIN PL
Practice Address - Street 2:1R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8316
Practice Address - Country:US
Practice Address - Phone:212-243-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055-849-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical