Provider Demographics
NPI:1881258531
Name:NIEVES, JEANNETTE (MRC, LRC, VEC)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MRC, LRC, VEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0336
Mailing Address - Country:US
Mailing Address - Phone:787-882-3230
Mailing Address - Fax:787-882-4605
Practice Address - Street 1:CARR 2 KM 126.4
Practice Address - Street 2:BO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-882-3230
Practice Address - Fax:787-882-4605
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR864101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor