Provider Demographics
NPI:1396212486
Name:NIEVES, MIRIAM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 WATERVISTA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-5540
Mailing Address - Country:US
Mailing Address - Phone:407-928-1810
Mailing Address - Fax:
Practice Address - Street 1:6501 MAGIC WAY BLDG 700
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5677
Practice Address - Country:US
Practice Address - Phone:407-317-3700
Practice Address - Fax:407-318-3020
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW72931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical