Provider Demographics
NPI:1336617950
Name:NIETO, NEWMAN N (MHC-LP, CASAC2)
Entity Type:Individual
Prefix:MR
First Name:NEWMAN
Middle Name:N
Last Name:NIETO
Suffix:
Gender:M
Credentials:MHC-LP, CASAC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3262
Mailing Address - Country:US
Mailing Address - Phone:718-377-5755
Mailing Address - Fax:718-377-0752
Practice Address - Street 1:1623 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3262
Practice Address - Country:US
Practice Address - Phone:718-377-5755
Practice Address - Fax:718-377-0752
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34082101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133952613Medicaid