Provider Demographics
NPI:1417544735
Name:DAVILA RIVERA, KEISHLA M (MSW)
Entity Type:Individual
Prefix:MISS
First Name:KEISHLA
Middle Name:M
Last Name:DAVILA 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 2100
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-2100
Mailing Address - Country:US
Mailing Address - Phone:787-764-2438
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MONACILLOS CALLE MAGA
Practice Address - Street 2:CENTRO MEDICO RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-764-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker