Provider Demographics
NPI:1689979221
Name:NIEFELD, JONATHAN JAYE (LISW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JAYE
Last Name:NIEFELD
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 KENMORE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3462
Mailing Address - Country:US
Mailing Address - Phone:440-935-4124
Mailing Address - Fax:
Practice Address - Street 1:2525 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3202
Practice Address - Country:US
Practice Address - Phone:216-696-5800
Practice Address - Fax:216-696-5768
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10003631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical