Provider Demographics
NPI:1396328571
Name:NIEVES, BIANCA MARIE
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:MARIE
Last Name:NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 SW 132ND AVE # 2
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5433
Mailing Address - Country:US
Mailing Address - Phone:954-549-5858
Mailing Address - Fax:
Practice Address - Street 1:5325 SW 132ND AVE # 2
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5433
Practice Address - Country:US
Practice Address - Phone:954-549-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-21-165733106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician