Provider Demographics
NPI:1003109588
Name:RIVERA, JULIO A
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLVD MEDIA LUNA # 3322
Mailing Address - Street 2:CONDOMINIO THE RESIDENCES APT. 1213
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-5135
Mailing Address - Country:US
Mailing Address - Phone:787-314-7850
Mailing Address - Fax:
Practice Address - Street 1:3522 BLVD. MEDIA LUNA APT. 1213
Practice Address - Street 2:CONDOMINIO THE RESIDENCES AT PARQUE ESCORIAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-314-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional