Provider Demographics
NPI:1730209107
Name:FAHSBENDER, NEILE (LCSW)
Entity type:Individual
Prefix:
First Name:NEILE
Middle Name:
Last Name:FAHSBENDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MAPLE ST
Mailing Address - Street 2:ATTN AQUILES
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4101
Mailing Address - Country:US
Mailing Address - Phone:732-324-8200
Mailing Address - Fax:
Practice Address - Street 1:540 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2405
Practice Address - Country:US
Practice Address - Phone:908-722-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052747001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical