Provider Demographics
NPI:1982337796
Name:RIVERA RIVERA, MARIELLI (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIELLI
Middle Name:
Last Name:RIVERA RIVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DRA. MARIELLI
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:CALLE 27 AA48 URB TOA ALTA HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2010
Mailing Address - Country:US
Mailing Address - Phone:939-881-1809
Mailing Address - Fax:
Practice Address - Street 1:BO MONACILLO CALLE MAGA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-766-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical