Provider Demographics
NPI:1649483959
Name:NIEVES, EVELYN JOSEFA (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:JOSEFA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LA GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1556
Mailing Address - Country:US
Mailing Address - Phone:908-644-5556
Mailing Address - Fax:
Practice Address - Street 1:121 LA GRANDE AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1556
Practice Address - Country:US
Practice Address - Phone:908-644-5556
Practice Address - Fax:908-490-1194
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053390001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical