Provider Demographics
NPI:1285835165
Name:RIVERA, MARIA SOCORRO I (PSID)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SOCORRO
Last Name:RIVERA
Suffix:I
Gender:F
Credentials:PSID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L11 CALLE RUBI
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4865
Mailing Address - Country:US
Mailing Address - Phone:787-738-8211
Mailing Address - Fax:
Practice Address - Street 1:L11 CALLE RUBI
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4865
Practice Address - Country:US
Practice Address - Phone:787-738-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1507103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic