Provider Demographics
NPI:1679022412
Name:RIVERA, CARMEN
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
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 1:500 CALLE GUAYANILLA
Mailing Address - Street 2:COND TOWN HOUSE APT 1701
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-765-2412
Mailing Address - Fax:
Practice Address - Street 1:500 CALLE GUAYANILLA
Practice Address - Street 2:COND. TOWN HOUSE APT. 1701
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3312
Practice Address - Country:US
Practice Address - Phone:787-765-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR56381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical