Individual
IAN NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
1500 SAINT GEORGES AVE STE E, AVENEL, NJ 07001-1000
(856) 772-5809
Mailing address
52 ABERDARE CT UNIT 7, FREEHOLD, NJ 07728-4918
(732) 614-8034
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06114300
NJ
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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