Provider Demographics
NPI:1588340095
Name:RIVERA, MIGUEL (MPSY)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CALLE CANALS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3022
Mailing Address - Country:US
Mailing Address - Phone:787-568-0573
Mailing Address - Fax:
Practice Address - Street 1:305 CALLE CANALS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3022
Practice Address - Country:US
Practice Address - Phone:787-568-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7737103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty