Provider Demographics
NPI:1548573298
Name:RIVERA, YESENIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YESENIA
Middle Name:
Last Name:RIVERA
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:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1676
Mailing Address - Country:US
Mailing Address - Phone:787-731-6966
Mailing Address - Fax:
Practice Address - Street 1:44 CALLE CARAZO
Practice Address - Street 2:OFICINA 2D
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5603
Practice Address - Country:US
Practice Address - Phone:787-615-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4185103TC0700X, 103TC2200X, 103TF0000X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging