Provider Demographics
NPI:1245462886
Name:NISSEL, LIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LIA
Middle Name:
Last Name:NISSEL
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 1:8127 CHEVY CHASE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1505
Mailing Address - Country:US
Mailing Address - Phone:718-454-6505
Mailing Address - Fax:
Practice Address - Street 1:8127 CHEVY CHASE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1505
Practice Address - Country:US
Practice Address - Phone:718-454-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR021418-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical