Provider Demographics
NPI:1417261777
Name:RIVERA, VICTOR D (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:D
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LL 22 SANTA JUANITA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6218
Mailing Address - Country:US
Mailing Address - Phone:787-940-1019
Mailing Address - Fax:
Practice Address - Street 1:SANTA JUANITA
Practice Address - Street 2:LL 22 30
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-940-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR54710101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral