Provider Demographics
NPI:1760562532
Name:NESLER, JOHANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:NESLER
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 1:242 W MAIN ST
Mailing Address - Street 2:#105
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7723
Mailing Address - Country:US
Mailing Address - Phone:949-322-3277
Mailing Address - Fax:
Practice Address - Street 1:242 W MAIN ST
Practice Address - Street 2:#105
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7723
Practice Address - Country:US
Practice Address - Phone:949-322-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS230651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical