Provider Demographics
NPI:1245501766
Name:CARLO RIVERA, ELIZABETH (PHD IN CL PSYCH)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:CARLO RIVERA
Suffix:
Gender:F
Credentials:PHD IN CL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 C-26 REPARTO ANAIDA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2534
Mailing Address - Country:US
Mailing Address - Phone:787-384-1795
Mailing Address - Fax:787-834-9597
Practice Address - Street 1:POLICLINICA BELLA VISTA 770 AVE HOSTOS OFIC 302
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-384-1795
Practice Address - Fax:787-834-9597
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical