Provider Demographics
NPI:1295860310
Name:NIEVES, LESLIE IVETTE (MFT)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:IVETTE
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S AMPHLETT BLVD STE 250C
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2728
Mailing Address - Country:US
Mailing Address - Phone:650-952-3774
Mailing Address - Fax:
Practice Address - Street 1:1700 S AMPHLETT BLVD STE 250C
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2728
Practice Address - Country:US
Practice Address - Phone:650-952-3774
Practice Address - Fax:650-286-7491
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist