Provider Demographics
NPI:1598727471
Name:RIVERA, DENNIS (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MA, PHD
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 10664
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0664
Mailing Address - Country:US
Mailing Address - Phone:787-841-4576
Mailing Address - Fax:787-841-4576
Practice Address - Street 1:CALLE 1 E-19 EL MADRIGAL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-1421
Practice Address - Country:US
Practice Address - Phone:787-841-4576
Practice Address - Fax:787-841-4576
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical