Provider Demographics
NPI:1063515492
Name:RIVERA-TORRES, MARIEL DEL C (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIEL
Middle Name:DEL C
Last Name:RIVERA-TORRES
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:PO BOX 140754
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0754
Mailing Address - Country:US
Mailing Address - Phone:787-374-1169
Mailing Address - Fax:787-878-5778
Practice Address - Street 1:113 ANTONIO R. BARCELO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84898Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST