Provider Demographics
NPI:1801298567
Name:RIVERA, MARIBEL (SW)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CALLE 14 NE
Mailing Address - Street 2:PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2331
Mailing Address - Country:US
Mailing Address - Phone:787-594-6211
Mailing Address - Fax:
Practice Address - Street 1:1104 CALLE 14 NE
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2331
Practice Address - Country:US
Practice Address - Phone:787-594-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR61851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6185OtherJUNTA EXAMINADORA DE TRABAJO SOCIAL