Provider Demographics
NPI:1851569198
Name:NIEVES RIVERA, MARIELY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIELY
Middle Name:
Last Name:NIEVES RIVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 20719
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8939
Mailing Address - Country:US
Mailing Address - Phone:939-599-1451
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #1 KM 26.9 BO. RIO CANAS SECTOR LA CHANGA
Practice Address - Street 2:OFICINA #3
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-599-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical