MEDICARE: MR. RAMON ANTONIO NIEVES JR. LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	010982	CT

General Provider Information

NPI Number	:	1700285319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAMON ANTONIO NIEVES JR. LCSW

Provider Business Mailing Address
First Line	:	7 WEBSTER DR
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-2522
Country	:	US
Telephone Number	:	203-751-3272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BRIDGEPORT AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-4660
Country	:	US
Telephone Number	:	203-712-9998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	03/01/2023

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