Active NPI
Angel O Nieves, PSYD
- Counseling Psychologist
- Tampa, FL
National Provider Identifier
1124443775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- Practice address
- 4411 W Gray St Unit 1
Tampa, FL 33609-2027 - Phone
- (813) 452-1555
- NPI assigned
- Feb 19, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 4150 | PR | |
| Counseling Psychologist | 103TC1900X | Primary |
Addresses
Primary practice location
4411 W Gray St Unit 1
Tampa, FL 33609-2027
Mailing address
4411 W Gray St Unit 1
Tampa, FL 33609-2027
Phone (813) 452-1555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4150 | PR | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631836800000",
"number": "1124443775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4411 W GRAY ST UNIT 1",
"city": "TAMPA",
"state": "FL",
"postal_code": "336092027",
"telephone_number": "813-452-1555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 W GRAY ST UNIT 1",
"city": "TAMPA",
"state": "FL",
"postal_code": "336092027",
"telephone_number": "813-452-1555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEVES",
"first_name": "ANGEL",
"middle_name": "O",
"name_prefix": "Mr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-19",
"last_updated": "2021-09-17",
"certification_date": "2021-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "PR",
"license": "4150",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.