Provider Demographics
NPI:1174659437
Name:NIELSEN-MEYERS, JEANNETTE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:A
Last Name:NIELSEN-MEYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0636
Mailing Address - Country:US
Mailing Address - Phone:631-444-2938
Mailing Address - Fax:
Practice Address - Street 1:34 ELEANOR PL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1917
Practice Address - Country:US
Practice Address - Phone:631-427-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04868611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical