Provider Demographics
NPI:1326270604
Name:RIVAS, ELSA (PSY D)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P7 CALLE A
Mailing Address - Street 2:REPTO VALENCIA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-4107
Mailing Address - Country:US
Mailing Address - Phone:787-391-2387
Mailing Address - Fax:
Practice Address - Street 1:P7 CALLE A
Practice Address - Street 2:REPTO VALENCIA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-391-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical