Basic Information
| Provider Information | |||||||||
| NPI: | 1891951380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIVEYRO | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | LUIS | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 GARDEN PL | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115501128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162920231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 796H DREW ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112084704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182353100 | ||||||||
| FaxNumber: | 7182770822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 002877-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.