Provider Demographics
NPI:1194021899
Name:RIVERA NIEVES, NAYCHALY (MA)
Entity Type:Individual
Prefix:PROF
First Name:NAYCHALY
Middle Name:
Last Name:RIVERA NIEVES
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 1:410 CALLE DE DIEGO
Mailing Address - Street 2:WINDSOR TOWER 711
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3000
Mailing Address - Country:US
Mailing Address - Phone:787-509-1665
Mailing Address - Fax:
Practice Address - Street 1:410 CALLE DE DIEGO
Practice Address - Street 2:WINDSOR TOWER 711
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3000
Practice Address - Country:US
Practice Address - Phone:787-509-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3936103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist