Provider Demographics
NPI:1063976736
Name:NIEVES-CASTILLO, SARA DALILA (BA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DALILA
Last Name:NIEVES-CASTILLO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CENTENNIAL DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7940
Mailing Address - Country:US
Mailing Address - Phone:978-927-9410
Mailing Address - Fax:978-531-1355
Practice Address - Street 1:9 CENTENNIAL DR UNIT 202
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7940
Practice Address - Country:US
Practice Address - Phone:978-927-9410
Practice Address - Fax:978-531-1355
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor