Provider Demographics
NPI:1689220600
Name:RIVERA SERRANO, JOEL JESUS (MA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:JESUS
Last Name:RIVERA SERRANO
Suffix:
Gender:M
Credentials:MA
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 1555
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1555
Mailing Address - Country:US
Mailing Address - Phone:787-433-6270
Mailing Address - Fax:
Practice Address - Street 1:ITURREGUI PLAZA SHOPPING CENTER
Practice Address - Street 2:1134 65TH INFANTRY AVE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-769-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6279103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling