Provider Demographics
NPI:1619378338
Name:RIVERA, BETHSA I
Entity Type:Individual
Prefix:
First Name:BETHSA
Middle Name:I
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
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 507
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0507
Mailing Address - Country:US
Mailing Address - Phone:787-828-5605
Mailing Address - Fax:
Practice Address - Street 1:# 78 CALLE GUILLERMO ESTEVES
Practice Address - Street 2:ALTOS PAYLEES
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-0507
Practice Address - Country:US
Practice Address - Phone:787-828-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR113991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical