Provider Demographics
NPI:1740685734
Name:STANISCLAUS, NIEVEL MARISA (CRC)
Entity type:Individual
Prefix:MS
First Name:NIEVEL
Middle Name:MARISA
Last Name:STANISCLAUS
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E 229TH ST
Mailing Address - Street 2:1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4614
Mailing Address - Country:US
Mailing Address - Phone:347-526-1932
Mailing Address - Fax:
Practice Address - Street 1:930 E 229TH ST
Practice Address - Street 2:1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4614
Practice Address - Country:US
Practice Address - Phone:347-526-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00085494225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor