Provider Demographics
NPI:1841743614
Name:NIEVES ACEVEDO, KEYLA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEYLA
Middle Name:MICHELLE
Last Name:NIEVES ACEVEDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 50371
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9112
Mailing Address - Country:US
Mailing Address - Phone:787-407-3805
Mailing Address - Fax:
Practice Address - Street 1:16-11 CARR 174 BLOQUE
Practice Address - Street 2:URB. SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-510-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical