Provider Demographics
NPI:1578021424
Name:RIVERA, ROSELYN M (MSW)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:M
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:PO BOX 71474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-618-1694
Mailing Address - Fax:
Practice Address - Street 1:PROFESSIONAL OFFICE PARK PFIZER TOWER SUITE 201
Practice Address - Street 2:ST ROBERTO STREET
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-329-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical