Provider Demographics
NPI:1700340734
Name:PANDISCIA, NANCY L
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:PANDISCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1002
Mailing Address - Country:US
Mailing Address - Phone:973-420-6764
Mailing Address - Fax:
Practice Address - Street 1:15 N FARVIEW AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2701
Practice Address - Country:US
Practice Address - Phone:551-579-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL061472001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical