Provider Demographics
NPI:1326599879
Name:NIEVES-PACHECO, CARMEN
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:NIEVES-PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:MILLIE
Other - Last Name:NIEVES-PACHECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:12 CYGNET RD
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1789
Mailing Address - Country:US
Mailing Address - Phone:917-309-9184
Mailing Address - Fax:
Practice Address - Street 1:12 CYGNET RD
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1789
Practice Address - Country:US
Practice Address - Phone:917-309-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12455101YA0400X
NYR065070-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)