Provider Demographics
NPI:1215648704
Name:NIEVES AGUILAR, GINNETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GINNETTE
Middle Name:
Last Name:NIEVES AGUILAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. RIO GRANDE ESTATES
Mailing Address - Street 2:R-59 AVE. B
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-5082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE PALMER #8
Practice Address - Street 2:LOCAL #3
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3116
Practice Address - Country:US
Practice Address - Phone:787-347-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7583103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical