Provider Demographics
NPI:1821311945
Name:RIVERA, MALKY IVETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MALKY
Middle Name:IVETTE
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:HC 77 BOX 7721
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9718
Mailing Address - Country:US
Mailing Address - Phone:787-515-0255
Mailing Address - Fax:
Practice Address - Street 1:HC 77 BOX 7721
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9718
Practice Address - Country:US
Practice Address - Phone:787-515-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3482103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical