Provider Demographics
NPI:1598096638
Name:NELSON, JAN LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 RIVER RD
Mailing Address - Street 2:6-C
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1456
Mailing Address - Country:US
Mailing Address - Phone:201-969-9117
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:20N-1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-8951
Practice Address - Fax:212-263-6233
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080984-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical