Provider Demographics
NPI:1356553614
Name:RIVERA, MARINILDA (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:MARINILDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DAKAR STREET FOREST VIEW
Mailing Address - Street 2:F174
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-599-8527
Mailing Address - Fax:787-772-4560
Practice Address - Street 1:BARBOSA AVE. # 414
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:787-772-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6661171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor