Provider Demographics
NPI:1104097591
Name:RIVERA, NORMA D (MA)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:D
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:D
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:PMB 163
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-5005
Mailing Address - Country:US
Mailing Address - Phone:787-685-0008
Mailing Address - Fax:
Practice Address - Street 1:BARRIO JAGUAL KM 7
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-685-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00395103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist