Provider Demographics
NPI:1184399230
Name:NIEVES, CRYSTAL L (RBT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:NIEVES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 CURRY FORD RD APT Z18
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2673
Mailing Address - Country:US
Mailing Address - Phone:610-570-2279
Mailing Address - Fax:
Practice Address - Street 1:3700 CURRY FORD RD APT Z18
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2673
Practice Address - Country:US
Practice Address - Phone:610-570-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-179568106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician