Provider Demographics
NPI:1407028160
Name:NIELSEN, MARIA SUE (MSW, LIMHP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SUE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MSW, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 N 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3670
Mailing Address - Country:US
Mailing Address - Phone:402-934-1617
Mailing Address - Fax:402-934-5228
Practice Address - Street 1:2126 N 117TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3670
Practice Address - Country:US
Practice Address - Phone:402-934-1617
Practice Address - Fax:402-934-5228
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13961041C0700X
NE1454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025339600Medicaid