Provider Demographics
NPI:1689415457
Name:CUEVAS, KARISSA ARIANNA (MA)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:ARIANNA
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GRISSOM DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-6844
Mailing Address - Country:US
Mailing Address - Phone:718-704-6853
Mailing Address - Fax:
Practice Address - Street 1:5350 SUMMIT BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-4801
Practice Address - Country:US
Practice Address - Phone:718-704-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-72232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst