Provider Demographics
NPI:1669939153
Name:NERIA, JAMES M (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:NERIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 N CLARK ST # 1157
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4620
Mailing Address - Country:US
Mailing Address - Phone:312-970-1787
Mailing Address - Fax:
Practice Address - Street 1:4610 N CLARK ST # 1157
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4620
Practice Address - Country:US
Practice Address - Phone:312-970-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0948671041C0700X
VA09040169841041C0700X
IL149.0229711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical