Provider Demographics
NPI:1497637110
Name:RIVERA-CASANOVA, GLORIANNE MARIE
Entity type:Individual
Prefix:
First Name:GLORIANNE
Middle Name:MARIE
Last Name:RIVERA-CASANOVA
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 1:463 CAMINO DE LA VEGA
Mailing Address - Street 2:URB.SABANERA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-242-2330
Mailing Address - Fax:
Practice Address - Street 1:463 CAMINO DE LA VEGA
Practice Address - Street 2:URB.SABANERA
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-242-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8521103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist