Provider Demographics
NPI:1508116617
Name:RIVERA, JASYRA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:JASYRA
Middle Name:MARIE
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 1:2430 CALLE EUREKA
Mailing Address - Street 2:CONSTANCIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2220
Mailing Address - Country:US
Mailing Address - Phone:787-922-6051
Mailing Address - Fax:
Practice Address - Street 1:2430 CALLE EUREKA
Practice Address - Street 2:CONSTANCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2220
Practice Address - Country:US
Practice Address - Phone:787-922-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR91791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical