Provider Demographics
NPI:1902037732
Name:RIVERA, DANZA YADIRA (MA)
Entity Type:Individual
Prefix:MISS
First Name:DANZA
Middle Name:YADIRA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARQUE SAN MIGUEL CALLE 1 BLOQUE A-14
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00959
Mailing Address - Country:UM
Mailing Address - Phone:787-530-2490
Mailing Address - Fax:787-251-7583
Practice Address - Street 1:PARQUE SAN MIGUEL CALLE 1 BLOQUE A-14
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00959
Practice Address - Country:UM
Practice Address - Phone:787-530-2490
Practice Address - Fax:787-251-7583
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3029103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling