Basic Information
| Provider Information | |||||||||
| NPI: | 1811535321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIEVES | ||||||||
| FirstName: | KIARA | ||||||||
| MiddleName: | IVETTE | ||||||||
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| OtherLastName: | NIEVES | ||||||||
| OtherFirstName: | KIARA | ||||||||
| OtherMiddleName: | IVETTE | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2167 SWANSON DR | ||||||||
| Address2: | |||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327386601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073762926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2479 ALOMA AVE | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327922541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076576692 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2019 | ||||||||
| LastUpdateDate: | 12/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.