Provider Demographics
NPI:1801014691
Name:DAVILA RIVERA, TERESA M (MSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:M
Last Name:DAVILA RIVERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 AMERICO MIRANDA AVE.
Mailing Address - Street 2:COND. LOS ROBLES APT. 310 A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-632-3382
Mailing Address - Fax:
Practice Address - Street 1:EA4 CALLE ROSA DE TEJAS
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4721
Practice Address - Country:US
Practice Address - Phone:787-632-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
005-5558Medicare ID - Type Unspecified