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General NPI Number Information
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NPI Number | 1184211047
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Entity Type | Individual
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Provider Name | WALESKA MARIEL NIEVES-YODER LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/27/2020
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Last Update Date | 12/27/2020
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Provider Practice Location Address
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Address Line | 2801 FRUITVILLE RD STE 110
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City | SARASOTA
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State | FL
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Zip | 34237-5336
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Country | US
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Telephone | 941-735-6714
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 FRUITVILLE RD STE 110
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City | SARASOTA
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State | FL
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Zip | 34237-5336
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Country | US
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Telephone | 941-735-6714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW14439
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License Number State | FL
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