Provider Demographics
NPI:1306685631
Name:RIVERA VAZQUEZ, NAHOMI JULISSE (MCSW)
Entity type:Individual
Prefix:
First Name:NAHOMI
Middle Name:JULISSE
Last Name:RIVERA VAZQUEZ
Suffix:
Gender:F
Credentials:MCSW
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 314
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-0314
Mailing Address - Country:US
Mailing Address - Phone:939-732-2596
Mailing Address - Fax:
Practice Address - Street 1:PARCELAS DOMINGO RUIZ CALLE 1 CASA 118-A
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:939-732-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR159761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical