Provider Demographics
NPI:1255873006
Name:RIVERA, NESTOR (LPC)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:V17 CALLE 25
Mailing Address - Street 2:VISTA AZUL
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-2619
Mailing Address - Country:US
Mailing Address - Phone:787-210-6880
Mailing Address - Fax:
Practice Address - Street 1:517 AVE MIRAMAR
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4371
Practice Address - Country:US
Practice Address - Phone:787-210-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional