Healthcare Provider Details

I. General information

NPI: 1699617175
Provider Name (Legal Business Name): MIKE M CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 MAIN ST FL 400
SPRINGFIELD MA
01103-1063
US

IV. Provider business mailing address

1695 MAIN ST FL 400
SPRINGFIELD MA
01103-1063
US

V. Phone/Fax

Practice location:
  • Phone: 413-650-1064
  • Fax:
Mailing address:
  • Phone: 413-650-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: