Provider Demographics
NPI:1306073648
Name:RIVERA, JOSE (MSW)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 4351
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9733
Mailing Address - Country:US
Mailing Address - Phone:787-485-8601
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 4351
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-9733
Practice Address - Country:US
Practice Address - Phone:787-485-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-13
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR48721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical