Provider Demographics
NPI:1194493411
Name:RODRIGUEZ-RIVAS, LIZ A
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:A
Last Name:RODRIGUEZ-RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. OLYMPIC PARK 146
Mailing Address - Street 2:CALLE 6 D-11
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9329
Mailing Address - Country:US
Mailing Address - Phone:787-216-2337
Mailing Address - Fax:
Practice Address - Street 1:CARR. 183 KM 19.2 SECTOR LA ROMANA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-216-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5573103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling