Provider Demographics
NPI:1841781036
Name:RIVERA TORRES, BRENDALIE (PSY)
Entity Type:Individual
Prefix:
First Name:BRENDALIE
Middle Name:
Last Name:RIVERA TORRES
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PROVINCIAS DEL RIO
Mailing Address - Street 2:91 CALLE TAYABOA
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:939-579-6236
Mailing Address - Fax:
Practice Address - Street 1:URB PROVINCIAS DEL RIO
Practice Address - Street 2:91 CALLE TAYABOA
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:939-579-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical