Provider Demographics
NPI:1508384397
Name:NELSON, GINETH (LCSW, CASAC)
Entity Type:Individual
Prefix:
First Name:GINETH
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6944 DE COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1116
Mailing Address - Country:US
Mailing Address - Phone:646-533-3277
Mailing Address - Fax:
Practice Address - Street 1:6944 DE COST AVENUE
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692
Practice Address - Country:US
Practice Address - Phone:646-533-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)