Provider Demographics
NPI:1821150061
Name:MERCED RIVERA, NANCY I
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:I
Last Name:MERCED 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 1:2 DA SECCION BONEVILLE HEIGTHS
Mailing Address - Street 2:CALLE 2 C-17
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-586-9648
Mailing Address - Fax:
Practice Address - Street 1:125 CALLE CARITE
Practice Address - Street 2:ESQUINA PARANA, URB. CROWN HILLS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-586-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR297101YA0400X
PR5496103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical