Provider Demographics
NPI:1225110927
Name:NIGRO, JEFFREY GERARD (LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GERARD
Last Name:NIGRO
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:G
Other - Last Name:NIGRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:1230 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5228
Mailing Address - Country:US
Mailing Address - Phone:843-614-7191
Mailing Address - Fax:843-718-0842
Practice Address - Street 1:1230 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5228
Practice Address - Country:US
Practice Address - Phone:843-614-7191
Practice Address - Fax:843-718-0842
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90701041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health