Provider Demographics
NPI:1255455762
Name:RIVERA, DESIREE (PHD)
Entity type:Individual
Prefix:DR
First Name:DESIREE
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 1:1500 AVE LOS ROMEROS APT 907
Mailing Address - Street 2:JARDINES DE MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-248-9344
Mailing Address - Fax:
Practice Address - Street 1:421 AVE MUNOZ RIVERA
Practice Address - Street 2:MIDTOWN BLDG, SUITE 412
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3416
Practice Address - Country:US
Practice Address - Phone:787-765-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical