Provider Demographics
NPI:1598787962
Name:NIERENBERG, BART (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:BART
Middle Name:
Last Name:NIERENBERG
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1428
Mailing Address - Country:US
Mailing Address - Phone:413-565-2840
Mailing Address - Fax:
Practice Address - Street 1:1200 CONVERSE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1760
Practice Address - Country:US
Practice Address - Phone:413-565-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1062111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1852868Medicaid
MA1852868Medicaid