Provider Demographics
NPI:1245789494
Name:RIVERA-BAUER, LYZAIDA IVETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYZAIDA
Middle Name:IVETTE
Last Name:RIVERA-BAUER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LYZAIDA
Other - Middle Name:IVETTE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1655 FORT MYER DR
Mailing Address - Street 2:820
Mailing Address - City:ROSSLYN
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1655 FORT MYER DR
Practice Address - Street 2:820
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3113
Practice Address - Country:US
Practice Address - Phone:850-321-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical