Provider Demographics
NPI:1114237138
Name:RIVERA, AMARILIS
Entity Type:Individual
Prefix:MS
First Name:AMARILIS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMARILIS
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PRADERA DEL RIO
Mailing Address - Street 2:CALLE RIO BUCANA 3004
Mailing Address - City:TOA ALTA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00953
Mailing Address - Country:UM
Mailing Address - Phone:787-448-7322
Mailing Address - Fax:
Practice Address - Street 1:PRADERA DEL RIO
Practice Address - Street 2:CALLE RIO BUCANA 3004
Practice Address - City:TOA ALTA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00953
Practice Address - Country:UM
Practice Address - Phone:787-448-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3152103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool