Provider Demographics
NPI:1831390673
Name:RIVERA, VIVIAN JEANNETTE (MSW)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:JEANNETTE
Last Name: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 1:3504 COND THE RESIDENCES
Mailing Address - Street 2:AVE. SUR APARTAMENTO 333
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-5014
Mailing Address - Country:US
Mailing Address - Phone:787-642-7604
Mailing Address - Fax:
Practice Address - Street 1:3504 COND THE RESIDENCES
Practice Address - Street 2:AVE. SUR APARTAMENTO 333
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-5014
Practice Address - Country:US
Practice Address - Phone:787-642-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical