Provider Demographics
NPI:1952571291
Name:NIEVES, DOMINICK RICHARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:RICHARD
Last Name:NIEVES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 E 142ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1723
Mailing Address - Country:US
Mailing Address - Phone:718-993-1400
Mailing Address - Fax:718-993-0647
Practice Address - Street 1:522 COURTLANDT AVE FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5008
Practice Address - Country:US
Practice Address - Phone:718-585-2153
Practice Address - Fax:718-585-2157
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079814-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical