Provider Demographics
NPI:1336430479
Name:RIVERA, LINA I (MA)
Entity Type:Individual
Prefix:MRS
First Name:LINA
Middle Name:I
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 PASEO AMAPOLA
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4310
Mailing Address - Country:US
Mailing Address - Phone:787-410-1720
Mailing Address - Fax:787-261-6693
Practice Address - Street 1:2231 PASEO AMAPOLA
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4310
Practice Address - Country:US
Practice Address - Phone:787-410-1720
Practice Address - Fax:787-261-6693
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3466103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3466OtherPSYCHOLOGIST LICENSE