Provider Demographics
NPI:1578338356
Name:RIVERA RIVERA, JONATHAN EMMANUEL
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EMMANUEL
Last Name:RIVERA RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CIUDAD PRIMAVERA CALLE BUENOS AIRES
Mailing Address - Street 2:1206
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-8518
Mailing Address - Country:US
Mailing Address - Phone:939-266-2459
Mailing Address - Fax:
Practice Address - Street 1:CIUDAD PRIMAVERA CALLE BUENOS AIRES
Practice Address - Street 2:1206
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-8518
Practice Address - Country:US
Practice Address - Phone:939-266-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR147311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical