Active NPI
Gaddiel Nieves, PSY.D
- Clinical Psychologist
- Moody AFB, GA
National Provider Identifier
1164823498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6250
- Practice address
- 3278 Mitchell Blvd
Moody AFB, GA 31699-1864 - Phone
- (229) 257-3898
- NPI assigned
- Sep 5, 2014
- Last updated
- Apr 25, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6250 | PR | Primary |
Addresses
Primary practice location
3278 Mitchell Blvd
Moody AFB, GA 31699-1864
Mailing address
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (724) 229-0331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250828004865 | PR | Order and Referring Only - Clinical Psychologist | 7113428392 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745539200000",
"number": "1164823498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3551 ROGER BROOKE DR",
"city": "FORT SAM HOUSTON",
"state": "TX",
"postal_code": "782344504",
"telephone_number": "724-229-0331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3278 MITCHELL BLVD",
"city": "MOODY AFB",
"state": "GA",
"postal_code": "316991864",
"telephone_number": "229-257-3898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEVES",
"first_name": "GADDIEL",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-09-05",
"last_updated": "2025-04-25",
"certification_date": "2025-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "6250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moody AFB, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.