Provider Demographics
NPI:1952633901
Name:RIVERA, RAYMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:SABANA SECA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-0783
Mailing Address - Country:US
Mailing Address - Phone:787-910-2567
Mailing Address - Fax:
Practice Address - Street 1:59 RAMON RIOS AVENUE
Practice Address - Street 2:SUITE 23
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00950
Practice Address - Country:US
Practice Address - Phone:787-910-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical