Provider Demographics
NPI:1013123819
Name:RIVERA, MERCEDES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 CALLE DE DIEGO
Mailing Address - Street 2:DE DIEGO CHALETS APARTAMENTO 32
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3101
Mailing Address - Country:US
Mailing Address - Phone:787-721-9151
Mailing Address - Fax:
Practice Address - Street 1:474 CALLE DE DIEGO
Practice Address - Street 2:DE DIEGO CHALETS APARTAMENTO 32
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3101
Practice Address - Country:US
Practice Address - Phone:787-721-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist