Provider Demographics
NPI:1780778258
Name:NELSON, JOSHUA (LCSW, LMFT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 RUGBY ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4551
Mailing Address - Country:US
Mailing Address - Phone:718-826-1119
Mailing Address - Fax:718-826-9199
Practice Address - Street 1:243 RUGBY ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4551
Practice Address - Country:US
Practice Address - Phone:718-826-1119
Practice Address - Fax:877-631-2970
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR047869-11041C0700X
NY000235-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300018375Medicare UPIN