Provider Demographics
NPI:1922657709
Name:RIVERA, KEISHLA M
Entity Type:Individual
Prefix:MISS
First Name:KEISHLA
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KEISHLA
Other - Middle Name:M
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:VILLA FONTANA PARK
Mailing Address - Street 2:CALLE PARQUE ASTURIAS 5X9
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-445-5366
Mailing Address - Fax:
Practice Address - Street 1:CALLE JULIO CINTRON 202
Practice Address - Street 2:EDIFICIO GUAYACAN OFICINA 107
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-445-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6420103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty