Provider Demographics
NPI:1184996886
Name:RIVERA, GISELLE MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CARR 19
Mailing Address - Street 2:CONDOMINIO CAMINO REAL, APARTAMENTO H-401
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-4101
Mailing Address - Country:US
Mailing Address - Phone:787-237-4771
Mailing Address - Fax:
Practice Address - Street 1:1500 CARR 19
Practice Address - Street 2:CONDOMINIO CAMINO REAL, APARTAMENTO H-401
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-4101
Practice Address - Country:US
Practice Address - Phone:787-237-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical