Provider Demographics
NPI:1972852176
Name:RIVAS, SANDRA I (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:I
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 02 BOX 6433
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00768
Mailing Address - Country:US
Mailing Address - Phone:787-457-6074
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 6433
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-8836
Practice Address - Country:US
Practice Address - Phone:787-457-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9545104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical