Provider Demographics
NPI:1942448055
Name:RIVERA, ROSA I (TS)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:I
Last Name:RIVERA
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT. ALTURAS DE SANTA ISABEL CALLE 5 E-1
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-298-3209
Mailing Address - Fax:787-845-1188
Practice Address - Street 1:AVE. LUIS MUNOZ RIVERA 91
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-1188
Practice Address - Fax:787-845-1188
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2527951104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker