Provider Demographics
NPI:1659992824
Name:NIEVES, JACLYN MARIE DOLAN (LMHC, CASAC)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MARIE DOLAN
Last Name:NIEVES
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:MS
Other - First Name:JACLYN
Other - Middle Name:MARIE
Other - Last Name:DOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 WHITE PLAINS RD STE 125
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5104
Mailing Address - Country:US
Mailing Address - Phone:914-440-3299
Mailing Address - Fax:
Practice Address - Street 1:1713 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1617
Practice Address - Country:US
Practice Address - Phone:914-438-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010790101YM0800X
NY34281101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)