Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC05290300 | NJ |
NPI | 1003079864 |
---|---|
Provider Name | Alicia Nashel-Watts |
First Address | Teaneck, NJ 07666-4457 |
Second Address | Teaneck, NJ 07666-4457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |