Provider Demographics
NPI:1811166432
Name:FONSECA-RIVERA, LILLIAN (PHD)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:
Last Name:FONSECA-RIVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. PANORAMA ESTATES A-15 CALLE 2
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-4379
Mailing Address - Country:US
Mailing Address - Phone:787-993-1938
Mailing Address - Fax:
Practice Address - Street 1:URB. PANORAMA ESTATES A-15 CALLE 2
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-0000
Practice Address - Country:US
Practice Address - Phone:787-993-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical