Healthcare Provider Details

I. General information

NPI: 1669609319
Provider Name (Legal Business Name): JOSE NIEVES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 LORD RD STE 215
MARLBOROUGH MA
01752-4549
US

IV. Provider business mailing address

28 LORD RD STE 215
MARLBOROUGH MA
01752-4549
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 781-666-2711
  • Fax: 781-666-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number218474
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: