Provider Demographics
NPI:1134790488
Name:NIEVES CARABALLO, LUIS E (SW)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:NIEVES CARABALLO
Suffix:
Gender:M
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STREET W23
Mailing Address - Street 2:URB. BAYAMON GARDENS
Mailing Address - City:BYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-226-5297
Mailing Address - Fax:
Practice Address - Street 1:CR8 3CV
Practice Address - Street 2:CALLE REV. DOMINGO MARRERO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-226-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
PR2120104100000X
PR7212103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty