Provider Demographics
NPI:1659001568
Name:ROQUE NIEVES, VILMA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:VILMA
Middle Name:A
Last Name:ROQUE NIEVES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BELLO HORIZONTE
Mailing Address - Street 2:CALLE 8 A 11
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-6601
Mailing Address - Country:US
Mailing Address - Phone:787-647-9644
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE GUAYAMA
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3314
Practice Address - Country:US
Practice Address - Phone:787-537-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical