Provider Demographics
NPI:1033508775
Name:RIVERA, ISRAEL (LCSW, TFC, TAC, TCC,)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LCSW, TFC, TAC, TCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1551
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9760
Mailing Address - Country:US
Mailing Address - Phone:787-217-7347
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 1551
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-9760
Practice Address - Country:US
Practice Address - Phone:787-217-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR114021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical