Healthcare Provider Details

I. General information

NPI: 1356972855
Provider Name (Legal Business Name): BRIANNA NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HOUGHTONS MILL RD
LUNENBURG MA
01462-1566
US

IV. Provider business mailing address

354A GREENWOOD ST SUITE B
WORCESTER MA
01607
US

V. Phone/Fax

Practice location:
  • Phone: 978-761-8162
  • Fax:
Mailing address:
  • Phone: 508-363-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71312
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: