Provider Demographics
NPI:1144618059
Name:NIEVES-BRULL, ADA IVETTE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:IVETTE
Last Name:NIEVES-BRULL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:MISS
Other - First Name:ADA
Other - Middle Name:IVETTE
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:393 NICOLLS ROAD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1805
Mailing Address - Country:US
Mailing Address - Phone:631-830-7342
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN STREET
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool