Provider Demographics
NPI:1912139916
Name:RIVERA NEGRON, MADELINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:
Last Name:RIVERA NEGRON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:RIVERA NEGRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:111 CALLE ANGELITO NIEVES
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5800
Mailing Address - Country:US
Mailing Address - Phone:787-248-7423
Mailing Address - Fax:
Practice Address - Street 1:CARR 115. KM 24.5 CALLE COLON #4
Practice Address - Street 2:EDIFICIO AGUADA COMPLEX 2DO PISO SUITE 5
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-248-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical