Provider Demographics
NPI:1912462151
Name:DAVID J NYER LCSW PC
Entity Type:Organization
Organization Name:DAVID J NYER LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-813-2682
Mailing Address - Street 1:1 BALA AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3217
Mailing Address - Country:US
Mailing Address - Phone:718-813-2682
Mailing Address - Fax:
Practice Address - Street 1:1 BALA AVE STE 125
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3217
Practice Address - Country:US
Practice Address - Phone:718-813-2682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386936565OtherNPI- INDIVIDUAL
1770977183OtherNPI- GROUP