Healthcare Provider Details

I. General information

NPI: 1174099378
Provider Name (Legal Business Name): MRS. LILLIAM PABON NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SANTA JUANITA L1 CALLE 37
BAYAMON PR
00956-4612
US

IV. Provider business mailing address

URB. MADELAINE L15 CALLE TOPACIO
TOA ALTA PR
00953-3555
US

V. Phone/Fax

Practice location:
  • Phone: 787-669-0294
  • Fax:
Mailing address:
  • Phone: 787-669-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6105
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: