Provider Demographics
NPI:1972262665
Name:RIVERA, AISHA MARIE (LCDA)
Entity Type:Individual
Prefix:MS
First Name:AISHA
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCDA
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 5030 PMB 0506
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:939-335-5075
Mailing Address - Fax:
Practice Address - Street 1:AVE NATIVO ALERS
Practice Address - Street 2:EDIFICIO MAGNOLIA SUITE #1
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-5233
Practice Address - Country:US
Practice Address - Phone:787-868-5149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7243103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling