Provider Demographics
NPI:1497874812
Name:NELSON, DAVID K (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:K
Last Name:NELSON
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8101 STATE HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4403
Mailing Address - Country:US
Mailing Address - Phone:315-541-3042
Mailing Address - Fax:315-541-3014
Practice Address - Street 1:214 KING ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1142
Practice Address - Country:US
Practice Address - Phone:315-713-5720
Practice Address - Fax:315-713-5741
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0793151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03182083Medicaid
NY03182083Medicaid