Provider Demographics
NPI:1104381946
Name:NIEVES GONZALEZ, MILLIANETSIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MILLIANETSIE
Middle Name:
Last Name:NIEVES GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 42078
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9916
Mailing Address - Country:US
Mailing Address - Phone:787-658-6536
Mailing Address - Fax:
Practice Address - Street 1:140 CALLE MONSENOR JOSE TORRES
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-5210
Practice Address - Country:US
Practice Address - Phone:787-877-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical