Provider Demographics
NPI:1134383953
Name:NIEVES-SERRANO, DALILA (PSY D)
Entity type:Individual
Prefix:DR
First Name:DALILA
Middle Name:
Last Name:NIEVES-SERRANO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0011
Mailing Address - Country:US
Mailing Address - Phone:787-897-5366
Mailing Address - Fax:
Practice Address - Street 1:8 MUNOZ RIVERA
Practice Address - Street 2:SUITE 4
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0000
Practice Address - Country:US
Practice Address - Phone:787-897-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2345103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TH0100X, 103TP2701X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool