Provider Demographics
NPI:1639487044
Name:RIVERA, MIQUELA CARLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIQUELA
Middle Name:CARLEEN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9633 VILLA DEL REY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1652
Mailing Address - Country:US
Mailing Address - Phone:505-514-9016
Mailing Address - Fax:
Practice Address - Street 1:9633 VILLA DEL REY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1652
Practice Address - Country:US
Practice Address - Phone:505-514-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist