Provider Demographics
NPI:1356972855
Name:NIEVES, BRIANNA
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354A GREENWOOD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607
Mailing Address - Country:US
Mailing Address - Phone:508-363-0200
Mailing Address - Fax:
Practice Address - Street 1:134 HOUGHTONS MILL RD
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1566
Practice Address - Country:US
Practice Address - Phone:978-761-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA1-24-71312103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist