Provider Demographics
NPI:1922456797
Name:NIEVES, RAQUEL (MS,)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CRISFIELD ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1230
Mailing Address - Country:US
Mailing Address - Phone:914-484-3740
Mailing Address - Fax:
Practice Address - Street 1:66 CRISFIELD ST APT 2G
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1230
Practice Address - Country:US
Practice Address - Phone:914-484-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool