Provider Demographics
NPI:1245857267
Name:NIEVES, DEBORAH (MS)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
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:PASEO DE LA VEGA
Mailing Address - Street 2:COND VISTAS DE LA VEGA APT 421
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-7714
Mailing Address - Country:US
Mailing Address - Phone:787-605-2564
Mailing Address - Fax:
Practice Address - Street 1:PASEO DE LA VEGA
Practice Address - Street 2:COND VISTAS DE LA VEGA APT 421
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-7714
Practice Address - Country:US
Practice Address - Phone:787-605-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5126103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2255608OtherDRIVER'S LICENSE