Provider Demographics
NPI:1407273436
Name:RIVERA HERNANDEZ, ROXANY (PSYD)
Entity Type:Individual
Prefix:
First Name:ROXANY
Middle Name:
Last Name:RIVERA HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# 30 CALLE JOSE C. BARBOSA
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00771
Mailing Address - Country:UM
Mailing Address - Phone:787-393-6566
Mailing Address - Fax:
Practice Address - Street 1:# 30 CALLE JOSE C. BARBOSA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00771
Practice Address - Country:UM
Practice Address - Phone:787-393-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical