Provider Demographics
NPI:1902637937
Name:ROSA RIVERA, STEPHANIE M
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:ROSA RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E18 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4513
Mailing Address - Country:US
Mailing Address - Phone:787-599-9311
Mailing Address - Fax:
Practice Address - Street 1:A3 AVE MIGUEL MELENDEZ MUNOZ
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4619
Practice Address - Country:US
Practice Address - Phone:787-602-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8035103T00000X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist