Provider Demographics
NPI:1376767160
Name:RIVERA, MYRA
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CENTRO DE AYUDA
Other - Middle Name:
Other - Last Name:ALAPAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11 CALLE JULIAN BLANCO
Mailing Address - Street 2:SANTA RITA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2804
Mailing Address - Country:US
Mailing Address - Phone:305-479-2484
Mailing Address - Fax:304-394-6413
Practice Address - Street 1:11 CALLE JULIAN BLANCO
Practice Address - Street 2:SANTA RITA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2804
Practice Address - Country:US
Practice Address - Phone:305-479-2484
Practice Address - Fax:304-394-6413
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling