Provider Demographics
NPI:1245260033
Name:NEVICOSI, CARLO JON (MSW, APSW)
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:JON
Last Name:NEVICOSI
Suffix:
Gender:M
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 FOREST PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-4109
Mailing Address - Country:US
Mailing Address - Phone:262-510-4877
Mailing Address - Fax:
Practice Address - Street 1:W4051 COUNTY RD. NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121
Practice Address - Country:US
Practice Address - Phone:262-741-3223
Practice Address - Fax:262-741-3217
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker