Provider Demographics
NPI:1639906472
Name:NIEVES CLARO, YANISLEYDIS
Entity type:Individual
Prefix:
First Name:YANISLEYDIS
Middle Name:
Last Name:NIEVES CLARO
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 1:1650 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4443
Mailing Address - Country:US
Mailing Address - Phone:786-832-3975
Mailing Address - Fax:
Practice Address - Street 1:1650 W 72ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4443
Practice Address - Country:US
Practice Address - Phone:786-832-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-365726106S00000X
FL1234103TF0000X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily