Provider Demographics
NPI:1366674475
Name:NIEVES, SONIA BEATRIZ
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:BEATRIZ
Last Name:NIEVES
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 1:13207 DUTROW DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4345
Mailing Address - Country:US
Mailing Address - Phone:240-606-5352
Mailing Address - Fax:301-916-4161
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:240-606-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)