Provider Demographics
NPI:1255472825
Name:NILES, ANN CIAGLIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:CIAGLIA
Last Name:NILES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:CIAGLIA
Other - Last Name:NILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:217 THORNDEN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1421
Mailing Address - Country:US
Mailing Address - Phone:973-738-9381
Mailing Address - Fax:
Practice Address - Street 1:217 THORNDEN ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1421
Practice Address - Country:US
Practice Address - Phone:973-738-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100470100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist