Provider Demographics
NPI:1346337425
Name:NIEMIRA, JAN CHRISTIAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:CHRISTIAN
Last Name:NIEMIRA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:609 COLUMBUS AVE
Mailing Address - Street 2:APT. 12-S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1408
Mailing Address - Country:US
Mailing Address - Phone:646-373-4845
Mailing Address - Fax:917-441-4340
Practice Address - Street 1:138 W 25TH ST
Practice Address - Street 2:SUITE 802, B-1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:646-373-4845
Practice Address - Fax:917-441-4340
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0748791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical