Provider Demographics
NPI:1689169427
Name:LITTLE, NYESHA MARIE
Entity type:Individual
Prefix:
First Name:NYESHA
Middle Name:MARIE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 GEORGE ST STE 320
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2091
Mailing Address - Country:US
Mailing Address - Phone:862-243-2147
Mailing Address - Fax:973-860-2282
Practice Address - Street 1:317 GEORGE ST STE 320
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2091
Practice Address - Country:US
Practice Address - Phone:862-243-2147
Practice Address - Fax:973-860-2282
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1255815486Medicaid
NJ1689169427Medicaid