Provider Demographics
NPI:1972796241
Name:NIEVES, IRVYN (MSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:IRVYN
Middle Name:
Last Name:NIEVES
Suffix:
Gender:M
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 AVE MONTE CARLO APT 334
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5743
Mailing Address - Country:US
Mailing Address - Phone:787-637-4672
Mailing Address - Fax:
Practice Address - Street 1:1306 AVE MONTE CARLO APT 334
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5743
Practice Address - Country:US
Practice Address - Phone:787-637-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7826104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker