Provider Demographics
NPI:1205205135
Name:NIEVES RIVERA, MIGUEL A (PHD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:NIEVES RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2017 #221
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-2017
Mailing Address - Country:US
Mailing Address - Phone:787-639-4903
Mailing Address - Fax:787-739-8190
Practice Address - Street 1:355 AVE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3249
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134107113OtherBEACON
MA1134107113Medicaid
MA997303OtherNETWORK HEALTH
MA1134107113OtherFALLON
1134107113OtherMBHP
MA042622756OtherCCA
MA1134107113OtherNHP
MA71756OtherTUFTS
MA12529OtherHNE
MAY10086OtherMEDICARE