Provider Demographics
NPI:1619360088
Name:NEAL, HAROLD REGGIE (LSW)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:REGGIE
Last Name:NEAL
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2109
Mailing Address - Country:US
Mailing Address - Phone:917-682-0337
Mailing Address - Fax:973-243-0075
Practice Address - Street 1:717 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2109
Practice Address - Country:US
Practice Address - Phone:917-682-0337
Practice Address - Fax:973-243-0075
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05216700101YM0800X, 102L00000X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist