Provider Demographics
NPI:1225190291
Name:RIVERA, GERARDO R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARQUE TERRALINDA
Mailing Address - Street 2:BOX 402
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-283-3346
Mailing Address - Fax:
Practice Address - Street 1:D12 CALLE BUEN SAMARITANO
Practice Address - Street 2:URB. GARDENVILLE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2025
Practice Address - Country:US
Practice Address - Phone:787-783-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical