Provider Demographics
NPI:1386172567
Name:CHARLES, NIRVEETA DEVIKA (LMFT)
Entity type:Individual
Prefix:
First Name:NIRVEETA
Middle Name:DEVIKA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3682 BAYVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3344
Mailing Address - Country:US
Mailing Address - Phone:347-829-4021
Mailing Address - Fax:
Practice Address - Street 1:101 HILLSIDE AVE STE D
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596
Practice Address - Country:US
Practice Address - Phone:347-829-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist