Provider Demographics
NPI:1568723963
Name:RIVERA, MILAGROS I (CPL)
Entity Type:Individual
Prefix:MRS
First Name:MILAGROS
Middle Name:
Last Name:RIVERA
Suffix:I
Gender:F
Credentials:CPL
Other - Prefix:MRS
Other - First Name:MILAGROS
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPL
Mailing Address - Street 1:HC-3
Mailing Address - Street 2:BOX 15424
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-9203
Mailing Address - Country:US
Mailing Address - Phone:787-531-4915
Mailing Address - Fax:787-851-7840
Practice Address - Street 1:13-201 CONDOMINIO ARMONIA
Practice Address - Street 2:LOS PRADOS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3280
Practice Address - Country:US
Practice Address - Phone:787-531-4915
Practice Address - Fax:787-851-7840
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101YA0400X, 106H00000X
PR0293101YM0800X, 101YP2500X
PR61135101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist