Provider Demographics
NPI:1225437189
Name:NOVA THERAPY, INC.
Entity Type:Organization
Organization Name:NOVA THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:NIEVES-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-674-4283
Mailing Address - Street 1:2231 PASEO AMAPOLA
Mailing Address - Street 2:URB LEVITOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4310
Mailing Address - Country:US
Mailing Address - Phone:787-674-4283
Mailing Address - Fax:
Practice Address - Street 1:2231 PASEO AMAPOLA
Practice Address - Street 2:URB LEVITOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4310
Practice Address - Country:US
Practice Address - Phone:787-674-4283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3466103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3466OtherPROFESSIONAL LICENSE