Provider Demographics
NPI:1922407907
Name:NIEVES, EDGARDO (MS)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:
Last Name:NIEVES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W CHELTEN AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4454
Mailing Address - Country:US
Mailing Address - Phone:267-974-3157
Mailing Address - Fax:
Practice Address - Street 1:408 W CHELTEN AVE APT 2R
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4454
Practice Address - Country:US
Practice Address - Phone:267-974-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health