Provider Demographics
NPI:1194988162
Name:NIEVES, PRISCILA ELIZABETH (MSW)
Entity type:Individual
Prefix:
First Name:PRISCILA
Middle Name:ELIZABETH
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 3158
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9514
Mailing Address - Country:US
Mailing Address - Phone:787-607-0168
Mailing Address - Fax:
Practice Address - Street 1:CALLE MCKINLEY W # 96
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3988
Practice Address - Country:US
Practice Address - Phone:787-833-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14990104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRZTA68103854801OtherCRUZ AZUL