Provider Demographics
NPI:1982934048
Name:NIETO COUNSELING & PSYCHOTHERAPY
Entity Type:Organization
Organization Name:NIETO COUNSELING & PSYCHOTHERAPY
Other - Org Name:NIETO COUNSELING & PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:YAZMIRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:NIETO-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-843-1826
Mailing Address - Street 1:151 W PASSAIC ST
Mailing Address - Street 2:SUITE 36
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3105
Mailing Address - Country:US
Mailing Address - Phone:201-843-1826
Mailing Address - Fax:201-368-2438
Practice Address - Street 1:151 W PASSAIC ST
Practice Address - Street 2:SUITE 36
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3105
Practice Address - Country:US
Practice Address - Phone:201-843-1826
Practice Address - Fax:201-368-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008518001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1982934048Medicare PIN