Provider Demographics
NPI:1407907827
Name:BRISTOL, NANCY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3102
Mailing Address - Country:US
Mailing Address - Phone:908-232-7274
Mailing Address - Fax:908-232-8677
Practice Address - Street 1:200 E DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3102
Practice Address - Country:US
Practice Address - Phone:908-232-7274
Practice Address - Fax:908-232-8677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC007633001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical