Provider Demographics
NPI:1871890624
Name:NIZNAN, NEAL RAYMOND (LCSW)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:RAYMOND
Last Name:NIZNAN
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 1:100 FOUR FALLS CORPORATE CTR
Mailing Address - Street 2:SUIT 312
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2950
Mailing Address - Country:US
Mailing Address - Phone:610-397-0950
Mailing Address - Fax:
Practice Address - Street 1:100 FOUR FALLS CORPORATE CTR
Practice Address - Street 2:SUIT 312
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2950
Practice Address - Country:US
Practice Address - Phone:610-397-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical