Provider Demographics
NPI:1891951380
Name:NIVEYRO, JORGE LUIS (LMHC)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:NIVEYRO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1128
Mailing Address - Country:US
Mailing Address - Phone:516-292-0231
Mailing Address - Fax:
Practice Address - Street 1:796H DREW ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4704
Practice Address - Country:US
Practice Address - Phone:718-235-3100
Practice Address - Fax:718-277-0822
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002877-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health