Provider Demographics
NPI:1972710069
Name:RIVERABERG, JOSE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:RIVERABERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 CALLE SERENATA
Mailing Address - Street 2:PALACIOS DE MARBELLA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5210
Mailing Address - Country:US
Mailing Address - Phone:787-786-3620
Mailing Address - Fax:
Practice Address - Street 1:1033 CALLE SERENATA
Practice Address - Street 2:PALACIOS DE MARBELLA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-5210
Practice Address - Country:US
Practice Address - Phone:787-786-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00994103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)