Provider Demographics
NPI:1497779615
Name:NEARE, PERRY DOUGLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:DOUGLAS
Last Name:NEARE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 STATE ROUTE 66 STE 5 STE D
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2625
Mailing Address - Country:US
Mailing Address - Phone:732-643-4367
Mailing Address - Fax:732-643-4378
Practice Address - Street 1:3535 STATE ROUTE 66 STE 5 STE D
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2625
Practice Address - Country:US
Practice Address - Phone:732-643-4367
Practice Address - Fax:732-643-4378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003540001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical