Provider Demographics
NPI:1275229130
Name:RIVERA, LOURDES GRACIELA (MSW)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:GRACIELA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70006
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4013
Mailing Address - Country:US
Mailing Address - Phone:787-801-0081
Mailing Address - Fax:787-522-3580
Practice Address - Street 1:151
Practice Address - Street 2:AVE. OSVALDO MOLINA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-0081
Practice Address - Fax:787-522-3580
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR92381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical