Provider Demographics
NPI:1134988835
Name:RIVERA, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 CALLE ORQUIDEA
Mailing Address - Street 2:ROUND HILL
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2713
Mailing Address - Country:US
Mailing Address - Phone:787-673-7686
Mailing Address - Fax:
Practice Address - Street 1:531 CALLE ORQUIDEA
Practice Address - Street 2:ROUND HILL
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2713
Practice Address - Country:US
Practice Address - Phone:787-673-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional