Provider Demographics
NPI:1790559318
Name:RIVERA BRUNO, ROSE MARY (MSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARY
Last Name:RIVERA BRUNO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION VILLA LINARES
Mailing Address - Street 2:CALLE 8 G-4
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-313-0895
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE PATRON, AVE ESQ COROZAL
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0068
Practice Address - Country:US
Practice Address - Phone:787-862-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR161041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical