Provider Demographics
NPI:1487798062
Name:NIEVES, ELAINE VANDA (MSW)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:VANDA
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 1:2785 PACIFIC COAST HWY # 455
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7066
Mailing Address - Country:US
Mailing Address - Phone:310-541-7617
Mailing Address - Fax:
Practice Address - Street 1:2785 PACIFIC COAST HWY # 455
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7066
Practice Address - Country:US
Practice Address - Phone:310-541-7617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker