Provider Demographics
NPI:1619376613
Name:ESMAEILI, NAZILA (LCSW)
Entity Type:Individual
Prefix:
First Name:NAZILA
Middle Name:
Last Name:ESMAEILI
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 1:2 CORNELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020
Mailing Address - Country:US
Mailing Address - Phone:516-582-2643
Mailing Address - Fax:
Practice Address - Street 1:2 CORNELL DRIVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020
Practice Address - Country:US
Practice Address - Phone:516-582-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055838001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical