Provider Demographics
NPI:1174332589
Name:NIEVES, DARISA PEGUERO (LCSW)
Entity type:Individual
Prefix:
First Name:DARISA
Middle Name:PEGUERO
Last Name:NIEVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 ROSEBAY LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9236
Mailing Address - Country:US
Mailing Address - Phone:401-588-1821
Mailing Address - Fax:
Practice Address - Street 1:1911 ROSEBAY LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9236
Practice Address - Country:US
Practice Address - Phone:401-588-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011661A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health