Provider Demographics
NPI:1821112590
Name:RIVERA, VANESSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PSYD
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 878
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0878
Mailing Address - Country:US
Mailing Address - Phone:787-786-8413
Mailing Address - Fax:787-786-8413
Practice Address - Street 1:CARR, 174 URB. AGUSTINE STAHL # 88 ALTOS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2818
Practice Address - Country:US
Practice Address - Phone:787-786-8413
Practice Address - Fax:787-786-8413
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22071Medicare ID - Type Unspecified